Journal articles on the topic 'Adult education – Uganda ; Widows – Uganda'

Despite current efforts to combat HIV/AIDS through behavioural change, ingrained socio-cultural practices such as widow inheritance in south-western Uganda has not changed. Low education, unemployment, dowry, widows' socioeconomic demands and the inheritor's greed for the deceased's wealth, influence widow inheritance. Voluntary counselling and testing is needed for the widows and their inheritors; formal dowry should be removed from marriage and widow inheritance stripped of its sexual component.

This article presents findings of study on women’s experiences of Functional Adult Literacy (FAL) as a gateway to their financial progress and welfare in Lango region, Northern Uganda. The qualitative study of 45 participants aimed at examining women’s live changes resulting from using their acquired FAL knowledge and skills to participate in Income Generating Activities. The study demonstrates that FAL brings out women’s individual and collective agency through “conscientization” concept and dialogue as tools for marginalized people in the act of social and economic change agents. This argument is grounded within agency concept that portray the power of the oppressed individual as well as collective agency. Findings revealed that FAL training improves women’s livelihood. The article concludes that Government, international development partners, NGOs, and civil society should ensure strong support and implementation of FAL program because it can help women succeed in the contemporary world.

Formerly shunned due its notoriety for facilitating illicit trade and transporting criminals across Uganda’s international borders, the boda-boda transport industry gained fame in recent years and has become the second largest employer of youths all over Uganda, after agriculture. Recent scholarship on the bodaboda industry has however, concentrated on the risks embedded in it including high infection rates of HIV among the drivers and the daily accidents reported. Little attention has been paid to the contribution of the industry in youth employment. This paper discusses the role of boda-boda transport industry in solving the problem of unemployment among the youths in Uganda. The author interviewed seventeen boda-boda drivers in Uganda and thirty-four of their family members to establish how this transport business has impacted on employment opportunities, financial independence and globalisation of youths. The study revealed that whereas many youths have dropped out of school to take up the boda-boda business, profits of this trade have facilitated the education of some young people in Uganda and enabled them to globally connect with youths across the globe. The study recommends sensitisation, business skills training as well as adult and distant education opportunities for the youthful motorcycle drivers

Illiteracy remains a global concern, especially among developing countries like Uganda. The 1990 World Education Conference in Jomtien, Thailand drew attention to the increasing number of illiterate individuals in the world, especially in developing countries. Consequently, the Education For All (EFA) campaign was launched, with UNESCO spearheading it. The campaign urged both developed and developing countries to invest in improving literacy and education levels among children and adults. The support for universal primary education has been enormous, with the United Nations putting forward eight Millennium Development Goals in 2000 to be achieved by 2015; goal 2 emphasizes universal primary education. This paper explores adult literacy promotion as an EFA effort and presents UNESCO’s drive for functional literacy. It also presents the Ugandan government’s Functional Adult Literacy Program and juxtaposes it against other alternative approaches to literacy learning, such as the social and sociocultural views of literacy. Findings from research conducted in 2006 and 2011 on the Functional Adult Literacy Program in Uganda not only point to program challenges limiting its effectiveness, but also call for a social approach to implementing any adult literacy program.

The increasing number of unemployed and underemployed youth across the globe, especially in developing countries, has reached alarming levels. In Africa, for example, this phenomenon has led to some youth making treacherous journeys across the Mediterranean Sea to Europe and other parts of the world in search of better livelihoods. Such an influx of immigrants, primarily to Europe and North America, has caused resentment and outcries by many citizens of the affected nations. Some of these challenges, however, could be allayed by engaging youth in income-generating projects, including agricultural entrepreneurship, i.e., agripreneurship, to create jobs and improve livelihoods. This may be achieved through Youth-Adult Partnerships (YAPs) by which youth and adults work together on agricultural projects of mutual interest. This study explored the experiences of adult partners in Uganda who collaborated with youth on their school-based, agripreneurial projects (SAPs) involving the raising of broiler chickens. Because of their partnership working on SAPs, both the youths’ and adults’ knowledge and understanding of concepts related to agripreneurship and raising of broilers chickens improved. The need exists to provide an enabling environment to promote an agripreneurial culture among youth through Y-APs if we seek to inspire them to pursue agripreneurship and related opportunities for job creation while also enabling the food security of communities and improved livelihoods for their citizens. Keywords: agripreneurship; improving livelihoods; project-based learning; school-based agripreneurial projects; youth unemployment; youth-adult partnerships

A community-based retrospective maternal mortality study using the Sisterhood method was conducted in Gulu district between February and March 1996. The objectives were to estimate the magnitude of and identify factors associated with maternal mortality in the district. Atotal of 5522 adult respondents, randomly selected from 27 parishes, of the five counties in the district were interviewed. Between 1960–1996 324 maternal deaths occurred in the sisterhood sample. The maternal mortality rate (MMR) was estimated to be 662 per 100 000 deliveries [95% confidence interval (CI) 421–839 per 100 deliveries]. The leading causes of maternal death were: haemorrhage 45.1%; obstructed labour 26.2%; puerperal sepsis 9.6%; anaemia 2.2%; AIDS 2.2%; and gunshot wounds (GSW) 1.0%. Factors associated with maternal mortality included: age − 31.8% of the mothers who died were below 20 years; education − 57.1% had no formal education; 65% of the mothers had delivered at home, 50.6% had been attended to by untrained traditional birth attendants (TBAs), while 37.8% were attended to by relatives. The MMR was found to be 1.3 times higher than the estimated national MMR of 500 per 100 000 deliveries. Most maternal deaths (80.9%) were due to preventable causes, being related to low socioeconomic status and low-level education of women in the district. The intractable civil war in the district was a major underlying and contributory factor to the high maternal mortality in the area. A multifaceted approach to reduce maternal mortality in the district should target improving the socioeconomic conditions in the district with special emphasis on encouraging and supporting female education. Intensive education on maternal healthcare in antenatal clinics be conducted targeting husbands/spouses and relatives who care for the prenatal/pregnant and postnatal mothers. There is need for more trained TBAs per village who should be given effective support supervision. Ambulance transport services, motor and bicycle be made available at the district and community levels. At a national level the security situation should be improved in the district.

The work/study programme for nurses and midwives at Aga Khan University School of Nursing and Midwifery (AKU-SONAM) is a unique concept in East Africa. This study explored whether nursing and midwifery students undergoing a work-study programme at AKU-SONAM felt their education was underpinned by an adult education philosophy. A semi-structured questionnaire designed specifically for this study based on the Knowles’ (1980) ‘Principles of Adult Education’ was administered to 96 students who completed their programmes in 2017 and 2018 respectively. Our paper reports on both the positive aspects of students’ experiences in this work-study programme, including the improvement of critical thinking skills and the direct transfer of classroom learning to clinical practice, along with negative impacts related to a poor work/life balance. Despite challenges related to quality and delivery highlighted in studies involving nursing and midwifery education in Africa, the findings of our study seem to show a positive experience in addressing the needs of the majority of the participants, as well as in meeting the objectives of the programme. We conclude that understanding the benefits and challenges faced by students will help to ensure the appropriate teaching and learning approaches. Keywords: Work/study programme, Uganda, Nurses and midwives evaluation, Upskilling, Nursing and midwifery educationHow to cite this article:Kyakuwaire, H., Kirikumwino, A., Nabossa, J. & Edwards, G.A. 2020. Evaluating a work/study programme for Nurses and Midwives at Aga Khan University, Uganda. Scholarship of Teaching and Learning in the South. 4(2): 63-79. https://doi.org/10.36615/sotls.v4i2.129.This work is licensed under the Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

Purpose. This study, designed to complement a large population survey on prevalence of stroke risk factors, assessed knowledge and perception of stroke and associated factors. Methods. A population survey was conducted in urban Nansana and rural Busukuma, Wakiso district, central Uganda. Adult participants selected by multistage stratified sampling were interviewed about selected aspects of stroke knowledge and perception in a pretested structured questionnaire. Results. There were 1616 participants (71.8% urban; 68.4% female; mean age: 39.6 years ± 15.3). Nearly 3/4 did not know any stroke risk factors and warning signs or recognize the brain as the organ affected. Going to hospital (85.2%) was their most preferred response to a stroke event. Visiting herbalists/traditional healers was preferred by less than 1%. At multivariable logistic regression, good knowledge of stroke warning signs and risk factors was associated with tertiary level of education (OR 4.29, 95% CI 2.13–8.62 and OR 5.96, 95% CI 2.94–12.06), resp.) and self-reported diabetes (OR 1.97, 95% CI 1.18–3.32 and OR 1.84, 95% CI 1.04–3.25), resp.). Conclusion. Knowledge about stroke in Uganda is poor although the planned response to a stroke event was adequate. Educational strategies to increase stroke knowledge are urgently needed as a prelude to developing preventive programmes.

Background and aimsIn sub-Saharan Africa, infectious diseases are still the leading causes of mortality; however, this may soon be surpassed by non-communicable illnesses, namely hypertension, diabetes and cardiovascular disease. This study determined the prevalence and patterns of metabolic syndrome and cardio-risk factors in men and women in rural Uganda.MethodsA household-based, cross-sectional survey was carried out following the WHO STEP-wise approach to surveillance. It included demographic and lifestyle questionnaires, anthropometric measurements and biochemical analyses. Of the 200 randomly recruited participants, 183 successfully completed two steps of the study and 161 provided blood samples.ResultsData were collected from 183 adults, aged 18–69 years; 62% were female. Based on the National Cholesterol Education Program-Adult Treatment Panel-III criteria, the prevalence of metabolic syndrome was 19.1% (95% CI 14.0 to 22.5). Elevated fasting plasma glucose was observed in 14.2% (95% CI 9.1 to 19.3) of participants, hypertriglyceridaemia in 16.9% (95% CI 12.1 to 23.1); hypertension in 36.1% (95% CI 29.0 to 43.0) and 52.5% (95% CI 45.2 to 59.6) had low HDL (high-density lipoprotein) cholesterol. Abdominal obesity was found in 24.6% (95% CI 18.8 to 31.4) of participants. Sex disparities were significant for several risk factors. Females had significantly higher prevalence of abdominal obesity (38.6% vs 1.5% in males, p=0.001) and twice the rates of low HDL (65.8% vs 30.4%, p=0.001). Men tended to have higher but not significant rates of hypertension (42.0% vs 32.5%) and smoked significantly more than women (49.3% vs 21.1%, p<0.001). Alcohol consumption was also higher in men (55.1% vs 18.4%, p<0.001) and quantities consumed were approximately three times greater than in females (p<0.001).ConclusionMetabolic syndrome exists at worrying rates in the rural Ugandan population. Sex disparities are evident in risk factor prevalence, reflecting physiological variables and deeply entrenched cultural and lifestyle norms.

quipping young people with livelihood skills is essential for positive youth development and empowerment as they transition into adulthood to become productive and engaged members of their communities. In Uganda, which may be the case in other nations of Sub-Saharan Africa, and elsewhere, even though many youth are becoming better educated and graduating from high schools and colleges, a majority of these graduates remain either unemployed or underemployed. Many have not acquired the necessary skills to transition from school to becoming employable and self-reliant. This phenomenon has been attributed to an outdated curriculum that does not meet the needs of contemporary times. Further, the mode of instruction in most of Uganda’s schools is teacher-centered and provides little room for student engagement and creativity to generate new knowledge, to have authentic learning experiences, or to reflect. Such challenges may be overcome through student-centered learning approaches involving School-Based, Agripreneurship Projects (SAPs) that integrate Youth-Adult Partnerships (YAPs), as were explored in this study. Evaluation of the students’ experiences through deductive and inductive thematic analysis indicated that they acquired knowledge in poultry science, business, agripreneurship, and life skills, including better communication, leadership, and conflict resolution practices. Longitudinal studies should be conducted to determine the longterm effectiveness and impact of SAPs facilitated by Y-APs on improving youth livelihoods, especially that prepare them with the life skills necessary to be productive citizens. Such research could involve cohort or panel investigations. Keywords: entrepreneurship; positive youth development (PYD); project-based learning (PjBL)

Introduction: Adolescents and young women become increasingly aware of their bodies through images presented to them through social structures during their developmental stage. These images may drive them toward unhealthy behaviors including overeating, starving, and skin bleaching. This paper is part of a study that examined the Older Adolescent Banyankole Girl’s Response to the socio-cultural constructions of body image in The Ankole Region, Uganda. It aimed to understand the self-perceptions of adolescent girls of their body image within Ankole society. Methods: The study collected narrative interviews of 30 adolescent and young adult females (16–24) recruited from various institutions of learning as well as the Ankole community of southwestern Uganda. Results: Adolescent girls’ perceptions of beauty were influenced by pull and push factors that included beauty expectations, beauty comparisons, relationships, and dietary habits that keep them oscillating between traditional and contemporary beauty ideals. Findings suggest that young women could benefit from social shifting of focus from physical appearance to other valuable developmental assets. Conclusion: Government-sponsored programs that provide education and positive media messages may be beneficial to building the self-esteem of young women.

ABSTRACT IMPACT: This research shows that physical intimate partner violence was associated with never testing for HIV while verbal intimate partner violence was associated with increased testing for HIV suggesting that HIV testing interventions should consider intimate partner violence prevention. OBJECTIVES/GOALS: HIV incidence is higher among women who experience intimate partner violence (IPV). However, few studies have assessed the association between HIV testing (regardless of the result) and the experience of IPV. Our objective was to assess the relationship between IPV and HIV testing among women from rural southwestern Uganda. METHODS/STUDY POPULATION: We conducted a whole-population, cross-sectional study including women ?18 years of age who were permanent residents in 8 villages of Rwampara District, southwestern Uganda from 2011-2012 who reported having a primary partner in the past 12 months. We surveyed participants to assess their exposure to 12 different forms of verbal, physical, and/or sexual IPV, and whether they had ever been tested for HIV. We used three separate modified Poisson regression models, clustering by village, to estimate the association between each type of IPV and ever testing for HIV, adjusting for categorical age, completion of more than primary education, and any food insecurity measured by the nine-item Household Food Insecurity Access Scale. RESULTS/ANTICIPATED RESULTS: Among 496 women with a primary partner (>95% response rate), 64 (13%) had never tested for HIV, 297 (60%) reported verbal IPV, 81 (16%) reported physical IPV, and 131 (26%) reported sexual IPV. Further, among these women, 208 (42%) were aged <30 years, 378 (76%) had a primary or no education, and 390 (79%) experienced food insecurity. Never having been tested for HIV was positively associated with physical IPV (adjusted risk ratio (ARR): 1.61, 95% confidence interval (CI): 1.02-2.56) and negatively associated with verbal IPV (ARR: 0.67, 95% CI: 0.44-0.99), but not sexual IPV (ARR: 1.05, 95% CI: 0.51-2.12). DISCUSSION/SIGNIFICANCE OF FINDINGS: Among this population of adult women with partners in Uganda, physical IPV was associated with never testing for HIV while verbal IPV was associated with increased testing for HIV. Evidence suggests that HIV testing interventions should consider IPV prevention, and future studies should focus on why certain IPV types impact HIV testing rates.

Intimate partner violence (IPV) is recognised as a fundamental violation of women’s human rights and a widespread phenomenon in Africa. Women’s low socioeconomic empowerment, cultural acceptability, and lack of social support exacerbate the health and psychosocial outcomes of IPV among African women. To date, there is no systematic research on IPV and its association with healthcare use among adult women in Uganda. Therefore, we conducted the present study on IPV among Ugandan women of childbearing age (15–49 years). Cross-sectional data on 7536 women were collected from the Uganda Demographic and Health Survey (UDHS—Uganda Demographic and Health Survey 2016). The objectives were to assess the predictors of IPV as well as help-seeking behaviour for victims of IPV. IPV was assessed by women’s experience of physical, emotional and sexual violence and healthcare use was assessed by self-reported medical visits during the last 12 months. Logistic regression methods were used to analyse the data. According to descriptive findings, which showed that more than half of the women reported experiencing any IPV (55.3%, 95%CI = 53.6, 57.0), emotional IPV (41.2%, 95%CI = 39.6, 42.8) was the most prevalent of all three categories, followed by physical (39.3%, 95%CI = 37.7, 40.9) and sexual IPV (22.0%, 95%CI = 20.7, 23.3). In the multivariate analysis, higher age, rural residence, religious background (non-Christian), ethnicity (Banyankore and Itseo), secondary/higher education and husband’s alcohol drinking habit were positively associated with women’s experience of IPV. Husband’s alcohol drinking was found to be a significant barrier to seeking help among those who experienced IPV. In conclusion, our findings suggest a noticeably high prevalence of IPV among Ugandan women. There are important sociodemographic and cultural patterns in the occurrence of IPV that need to be taken into account when designing intervention policies. Special attention should be given to women living with husbands/partners who drink alcohol, as this might increase their odds of experiencing IPV, as well as reduce the likelihood of seeking help.

Background Transition readiness refers to a client who knows about his/her illness and oriented towards future goals and hopes, shows skills needed to negotiate healthcare, and can assume responsibility for his/ her treatment, and participate in decision-making that ensures uninterrupted care during and after the care transition to adult HIV care. There is a paucity of research on effective transition strategies. This study explored factors associated with adolescent readiness for the transition into adult care in Uganda. Methods A cross-sectional study was conducted among 786 adolescents, and young people living with HIV randomly selected from 9 antiretroviral therapy clinics, utilizing a structured questionnaire. The readiness level was determined using a pre-existing scale from the Ministry of Health, and adolescents were categorized as ready or not ready for the transition. Bivariate and multivariate analyses were conducted. Results A total of 786 adolescents were included in this study. The mean age of participants was 17.48 years (SD = 4). The majority of the participants, 484 (61.6%), were females. Most of the participants, 363 (46.2%), had no education. The majority of the participants, 549 (69.8%), were on first-line treatment. Multivariate logistic regression analysis found that readiness to transition into adult care remained significantly associated with having acquired a tertiary education (AOR 4.535, 95% CI 1.243–16.546, P = 0.022), trusting peer educators for HIV treatment (AOR 16.222, 95% CI 1.835–143.412, P = 0.012), having received counselling on transition to adult services (AOR 2.349, 95% CI 1.004–5.495, P = 0.049), having visited an adult clinic to prepare for transition (AOR 6.616, 95% CI 2.435–17.987, P = < 0.001) and being satisfied with the transition process in general (AOR 0.213, 95% CI 0.069–0.658, P = 0.007). Conclusion The perceived readiness to transition care among young adults was low. A series of individual, social and health system and services factors may determine successful transition readiness among adolescents in Uganda. Transition readiness may be enhanced by strengthening the implementation of age-appropriate and individualized case management transition at all sites while creating supportive family, peer, and healthcare environments.

Globally, Routine Medical checkup is known to be a preventive medicine that opens doors for assessment of well-being status of all individual and decreases the mortality and morbidity of different ailments in communities. attending health checkups may be one of the key reasons of controlling the predisposition and cause of much of the illness, suffering and early death related to chronic illnesses and condition. Its on this ground that this current study sought to elucidate further on factors determining the adherence of people to medical checkups. A descriptive cross-sectional study was carried out among 385 adult respondents attending Masaka regional referral hospital, in Uganda. A structured questionnaire involving open-ended and close-ended questionnaire was used and data was analyzed using SPSS version 26. Overall, 61.3% of study participants have ever heard of routine health check-ups citing hospitals (25.7%) as the most used source of the information. A prevalence of 43.4% represents the percentage of those who do routine health check-up and of which majority engage in only a general examination (14.5%). Overall, more than half of the respondents (56.6%) have never participated in routine health check-ups with their reported reasons of not feeling sick (25.97%). Factors like level of education, Employment, Occupational, exercise practices and level of awareness was statistically significant to uptake of routine heath checkup among the respondent at P< (0.005). Low health check-up rates may translate into inability to detect and intervene with early health challenges among respondents, and this is whereeffort is needed in ensuring that routine health check-up is encouraged especially during times when patients are healthy. There is need to strengthen government efforts and other concerned NGOs to put across specific sensitization programs about routine health check-ups on different media platforms and also utilize other social public means.

ABSTRACT Background Food for education (FFE) programs that include school meals are widely used to improve school participation and performance, but evidence on nutritional benefits is limited. Objective This study tested whether food fortified with multiple micronutrients provided in FFE programs reduced anemia prevalence of primary-school-age adolescent girls, adult women, and preschool children. Methods Through the use of a cluster randomized controlled trial with individual-level repeated cross-sectional data, we measured impacts on anemia prevalence from 2 FFE programs, a school feeding program (SFP) providing multiple-micronutrient-fortified meals and a nutritionally equivalent take-home ration (THR). Camps for internally displaced people (IDP) (n = 31) in Northern Uganda were randomly assigned to SFP, THR, or a control group with no FFE. Rations were provided for 15 mo at SFP and THR schools. A survey of households (n = 627) with children aged 6–17 y was conducted (baseline and 18 mo later). Analyses used difference-in-differences by intent to treat. Results Adolescent girls aged 10–13 y in FFE schools experienced a significant (P < 0.05) 25.7 percentage point reduction (95% CI: −0.43, −0.08) in prevalence of any anemia [hemoglobin (Hb) <11.5 g/dL, age 10–11 y; Hb <12 g/dL, age 12–13 y] and a significant 19.5 percentage point reduction (95% CI: −0.35, −0.04) in moderate-to-severe anemia (Hb <11 g/dL) relative to the control group, with no difference in impact between SFP and THR. The THR reduced moderate-to-severe anemia prevalence (Hb <11g/dL) of adult women aged ≥18 y (12.8 percentage points, 95% CI: −0.24, −0.02). All IDP camps initially received micronutrient-fortified rations through a separate humanitarian program; in one district where most households stopped receiving these rations, SFP reduced moderate-to-severe anemia of children aged 6–59 mo by 22.1 percentage points (95% CI: −0.42, −0.02). Conclusions FFE programs reduced any anemia and moderate-to-severe anemia in primary-school-age adolescent girls and reduced moderate-to-severe anemia for adult women and preschool children. This study was registered with clinicaltrials.gov as NCT01261182.

Background:Data on physical inactivity, a known risk factor for noncommunicable diseases and its correlates in sub-Saharan Africa are almost absent. We assessed physical activity patterns and associated factors among adults.Methods:A populationbased study of 1208 adults was conducted in the Iganga-Mayuge Health and Demographic Surveillance Site, Uganda. Physical activity was assessed using a pedometer for 7 days. Physical inactivity was defined as a daily average of < 7500 steps while sedentary behavior was defined as a daily average of < 5000 steps. Logistic regression was conducted to identify factors associated with physical inactivity and sedentary behavior.Results:Of the 1208 participants, 18.8% were sedentary (10.6% of men; 26.9% of women, P < .001), 37.6% were physically inactive (28.5% of men; 46.6% of women, P < .001). Factors associated with sedentary behavior were being female, ≥ 65 years, peri-urban residence, being a domestic worker, formal employment and lower primary education. Factors associated with physical inactivity were being female, 55 to 64 years, ≥ 65 years, peri-urban residence, overweight and obesity.Conclusions:Sedentary behavior and physical inactivity were prevalent among the adult population. Targeted physical activity promotion interventions are needed.

Globally, the prevalence of metabolic syndrome (MetS) and its components which are the major cardiovascular disease (CVD) risk factors, is higher among patients with severe mental illness (SMI) compared to the general population. This is mainly due to the deleterious lifestyles characterized by physical inactivity, excessive alcohol consumption, smoking, and unhealthy diets common among patients with SMI as well as due to cardiometabolic effects of psychotropic medications. Despite these conditions being highly prevalent among patients with SMI, little attention is given to these conditions during routine reviews in the mental health clinics in most low-income countries including Uganda. The main objective of this study was to determine the prevalence and associated factors of MetS among patients with SMI at Mbarara Regional Referral Hospital (MRRH), a tertiary hospital in southwestern Uganda. Through a cross-sectional study at the mental health clinic of the hospital, we recruited 304 patients with SMI and evaluated them for MetS using the National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) criteria. We defined the prevalence of MetS as the proportion of patients meeting the NCEP ATP III criteria. We used logistic regression to evaluate associations between MetS and independent variables. We included a total of 302 (44.37% male, 55.63% female) patients with a diagnosis of SMI in the analysis. The prevalence of MetS was 23.51% (95% CI 18.84–28.71). At multivariable logistic regression, age >40 years and long duration of mental illness (>10 years) were significantly associated with MetS. The prevalence of MetS is high among patients with psychiatric disorders, and thus metabolic screening, especially among the high-risk groups, is critical.

Background. Clinical benefits of ART are well documented, but less is known about its effects on economic outcomes such as work status and income in sub-Saharan Africa.Methods. Data were examined from 482 adult clients entering HIV care (257 starting ART; 225 not yet eligible for ART) in Kampala, Uganda. Self-reported data on work status and income were assessed at baseline, months 6 and 12. Multivariate analysis examined the effects of ART over time, controlling for change in physical health functioning and baseline covariates.Results. Fewer ART patients worked at baseline compared to non-ART patients (25.5% versus 34.2%); 48.8% of those not working at baseline were now working at month 6, and 50% at month 12, with similar improvement in both the ART and non-ART groups. However, multivariate analysis revealed that the ART group experienced greater improvement over time. Average weekly income did not differ between the groups at baseline nor change significantly over time, among those who were working; being male gender and having any secondary education were predictive of higher income.Conclusions. ART was associated with greater improvement in work status, even after controlling for change in physical health functioning, suggesting other factors associated with ART may influence work.

THE SUSTAINABLE FUTURES IN AFRICA (SFA) NETWORK<br/> The Sustainable Futures in Africa (SFA) Network is an interdisciplinary collective that brings together researchers, educators, and communities of practice that acknowledge the situated and complex nature of practices and conceptions of sustainability. The Network aims to build understanding, research, and practice in socio-ecological sustainability in Africa.<br/> Specifically, the Network includes the participation of researchers (from geography and earth sciences, community and adult education, applied social arts, health sciences, and engineering); third-sector organisations (working with environmental and social sustainability, with arts and cultural practice, and with community engagement in African contexts); and community stake-holders (living and working in areas of focus). Participants currently span the Uganda, Botswana, Nigeria, Malawi, and the UK, and the reach of the network continues to expand.<br/> THE NETWORK'S AIMS ARE:<br/> To address the relationship between social, cultural, and ecological factors in sustainability in Africa through interdisciplinary research initiatives To discover opportunities in the disparities between ontologies of the global north and the global south inherent in international collaborations and global endeavours To shape and support new opportunities for impact and inquiry that address locally-articulated, socio-ecological challenges The Network’s current infrastructure includes a website (https://sustainablefuturesinafrica.com/) and social media platforms; a growing base of research, funding to support knowledge sharing and capacity strengthening (ESRC, EPSRC & SFC); and a core group of scholars, practitioners, and support staff who are providing the leadership and administration of this initiative.

Abstract Objectives Water insecurity may coincide with and exacerbate food insecurity and poor nutrition and health. The Household Water Insecurity Experiences (HWISE) Scale permits quantification and comparison of water access and use across low- and middle-income countries (LMICs). With Gallup and UNESCO, we collected the first nationally representative data on water insecurity in half the world's population. We investigated the national prevalence of water insecurity and predictors of altered food choice resulting from problems (in quantity, quality, or stability) with water. Methods The 2020–2021 Gallup World Poll administered the 12-item HWISE module to individuals ≥ 15 y in 31 countries in Africa, Asia, and South America. Responses to each item were “never,” “1–2 months,” “some, not all months,” and “almost every month” (scored 0–3, total range 0–36) in the prior 12 months. One HWISE item asked the frequency with which respondents changed what was eaten due to water problems. Ordered logistic regression models controlling for country fixed effects examined the odds of reporting a higher frequency of water-induced changes in food choices in relation to 10-y-increment age groups, sex, rural/urban residence, marital status, education, number of children and adult household members, 27 income brackets, difficulty affording shelter, and social support. Results In the seven countries for which data were available at the time of submission (China, Congo Brazzaville, Ghana, Ivory Coast, Mauritius, Uganda, and Zambia, n = 8,916), the national prevalence of water insecurity (HWISE score &gt; 12) ranged from 2.4 ± 0.4% in China to 42.7 ± 2.1% in Zambia. Higher odds of water-induced changes in food choices were found for each additional child (OR: 1.05; 95% CI: 1.02, 1.08) and with difficulty affording shelter (OR: 1.90; 95% CI: 1.69, 2.14). Lower odds of water-induced changes in food choices were found for each higher income bracket (OR: 0.97; 95% CI: 0.96, 0.98) and amongst those with social support (OR: 0.76; 95% CI: 0.67, 0.87) and those &gt; 65 years of age relative to other age groups (ORs ranging from 0.50–0.60; all P &lt; 0.02). Conclusions Water insecurity is a concern in many LMICs and may constrain food choices for people experiencing other social and economic hardships. Funding Sources Carnegie Corporation and United State Agency for International Development Cooperative Agreement.

Livelihood adaptation in refugee camps is often fragile and inherently problematic owing to their physical characteristics and policy restrictions. The Uganda refugee policy applauded as progressive exhibits internal contradictions which influence livelihoods. The purpose of this study is to explore the significant role of adult education in livelihood adaptation. The study used qualitative research methods of interviews and focus group discussions. Purposive sampling technique was used in selecting 70 participants from eight Common Interest Groups, of both refugees and Ugandan nationals. The findings indicate that access to agriculture extension education and financial literacy facilitates the acquisition of relevant skillsets for adaptation. The study concludes that adult education provides immediate, relevant skillsets for adaptation.

Abstract Background The prevalence of diabetes has been rising increasing rapidly in middle- and low-income countries. In Africa, the World Health Organization projections anticipate diabetes mellitus to be the seventh leading cause of death in by 2030. Alcohol consumption influences diabetes evolution, in such a way that it can interfere with self-care behaviours which are important determinants of diabetes prognosis. In this study, we evaluated factors associated with alcohol consumption among persons with diabetes in Kampala to inform management policies and improve comprehensive diabetes care. Methodology A cross-sectional study was conducted systematically among 290 adults with diabetes, attending diabetic clinics at Mulago National Referral Hospital and St Francis Hospital Nsambya. Data were entered and analysed in Epi-Info version 7 and STATA 13 software. Modified Poisson regression was used to identify factors associated with alcohol consumption among persons with diabetes. All tests were two-sided and the significance level for all analyses was set to p < 0.05. Results The prevalence of alcohol consumption among persons with diabetes was 23.45% [95% CI: 18.9–28.7%]. Divorced, separated and widowed patients (Adj PR: 0.42, 95% CI: 0.21–0.83); and Protestant (Adj PR: 0.44, 95% CI: 0.24–0.82); Muslim (Adj PR: 0.30, 95% CI: 0.14–0.62); and Pentecostal (Adj PR: 0.32, 95% CI: 0.15–0.65) patients were less likely to consume alcohol. Diabetic patients who had a diabetes duration greater than 5 years were more likely to consume alcohol (Adj PR: 1.90, 95% CI: 1.25–2.88). Conclusion Approximately one-quarter of participants consumed alcohol. However being catholic, never being married and having diabetes for more than 5 years predisposed persons with diabetes to alcohol consumption. Sensitization messages regarding alcohol consumption among persons with diabetes should be target patients who have never been married and those who have spent more than 5 years with diabetes; religion should also be considered as an important venue for health education in the community.

Knowledge of mortality trends and predictors among HIV-positive patients in the era of highly active antiretroviral therapy (HAART) in resource poor settings is still limited. The aim of this study was to describe trends and predictors of mortality among HIV-positive patients in the era of HAART in Uganda. Data from 2004 to 2013 for adult HIV-positive patients (≥15 years) obtaining care and treatment from the AIDS Support Organization in Uganda were reviewed for mortality. Descriptive statistics were analyzed by frequencies and cross tabulations. Calendar period was used as a proxy measure for HAART exposure and a time plot of the proportion of HIV-positive patients reporting dead per year was used to describe the trends. Logistic regression was used to determine the predictors of mortality at bivariate and multivariate levels, respectively. We included in the analysis 95,857 HIV positive patients; 64% were female with median age of 33 years (interquartile range 27-40). Of these 36,133 (38%) were initiated on ART and a total of 4279 (4.5%) died; 19.5% (835/4279) of those who died had an opportunistic infection. Overall, mortality first increased between 2004 and 2006 and thereafter substantially declined (X2trend=211.9, P&lt;0.001). Mortality was relatively higher in Eastern Uganda compared to other geographical areas. Male gender, older age (&gt;45 years), being from Eastern or Northern Uganda, having none or primary education, being unemployed, advanced immunodeficiency (CD4 count &lt;100 cell/μL or WHO stage III or IV) and underweight (&lt;45 kg weight) at HAART initiation and calendar period 2004-2008 were significant predictors of mortality (P&lt;0.001). Overall, the expanding coverage of HAART is associated with a declining trend in mortality among HIV positive patients in Uganda. However, mortality trends differed significantly by geographical area and men remain potentially at higher risk of death probably because of delayed initiation on ART. There is urgent need for men targeted interventions for improved ART performance.

Nutrition is a very important component for the growth and development of any society, specifically for the prevention and control of a range of diseases. In Tanzania, despite a great variability of nutrition status by different characteristics, generally the majority of the populations have poor nutrition. Kagera is among the 26 regions of mainland Tanzania with a total projected population of about 2.5 million. The nutrition status among residents is poor with multifactorial determinants. In this paper, we present qualitative data collected using in-depth interviews with key adult men and women informants in the four Tanzania-Uganda border districts. The main objective was to establish possible causes of the reported low nutrition in Kagera Region. Majority of study participants were affirmative of the availability and plenty of food; the main problem being poor dietary diversification knowledge, attitudes, skills, and practices. They recommend various measures that could improve the current nutrition status. These measures include nutrition education at primary, secondary and tertiary levels; health education at health facility level that will include nutrition topics and peer education at community level; introduction of nutrition bylaws in the community and vitalizing peer education social groups among males and females about the importance of dietary diversification. Therefore, future nutrition research should include culture, religion, and traditional indicators to inform food and nutrition interventions and policy in similar populations to the Tanzania-Uganda borderlanders.

Globally and specifically within the sub-Saharan African region, the nutritional status of children under five has remain a public health concern. Deficiency in nutrients has been documented as a cause of morbidity and mortality in children under five in most developing countries. The study was conducted to determine factors influencing malnutrition among children under five in Adjumani district in Uganda. The study design adopted was a descriptive and cross-sectional type. Three hundred children aged under five years together with either their mothers or adult care givers were selected. An interviewer administered structured questionnaire was completed by 200 mothers/caregivers. Nutritional status was assessed by anthropometric measurements while focus group discussions with medical personnel and direct observation were also conducted. The result depicts that Wasting was significantly associated with sex of the children with females more likely to be wasted than males (p=0.023). Age of the studied children was found to be significantly associated with mid upper arm circumference (p<0.001). Also education level of mothers/care givers was significantly associated with malnutrition of children under five. (P value 0.013). Stunting and underweight were identified as the main nutrition problems in Adjumani District. Poor weaning practices, poor sanitation due to inadequate hand washing and poor maintenance of latrine as well as low income for house hold due to few loan/ credit facilities were identified as factors influencing malnutrition. The study therefore recommends that nutrition survey for children under five should be done regularly at community level. Sanitation can be improved by availing hand washing facility for each latrine. Female education be encouraged while agriculture to should be modernized in order to boost household income and improve food security.

AbstractAdequate sanitation is one of the most important aspects of community well-being. It reduces the rates of morbidity and severity of various diseases like diarrhea, dysentery, and typhoid among others. A study about toward the attainment of the recommended Humanitarian Sphere Standards on sanitation in Bidibidi refugee camp, Yumbe District, was initiated. A total of 210 households distributed in Bidibidi refugee camp were randomly selected and one adult person interviewed to assess the accessibility of different sanitation facilities, and to explore the sanitation standards of the sanitation facilities in relation to the recommended Humanitarian Sphere Standards in the area. Pit latrines, hand washing facilities, and solid waste disposal areas as reported by 81.4%, 86.7%, and 51.9% of the respondents respectively, are the main sanitation facilities accessed in the refugee camp. Despite their accessibility, the standards of the pit latrines, hand washing, and solid waste disposal facilities are below the recommended standards, which might have contributed to the outbreak of sanitation related diseases (χ2 = 19.66, df = 1, P = 0.05) in Bidibidi refugee camp. The respondents in the study area were aware that the presence of the sanitation-related diseases was because of the low-level sanitation practices in place (χ2 = 4.54, df = 1, P = 0.05). The inaccessibility to some sanitation facilities by some respondents was found to be related to their low level of education (χ2 = 130.37, df = 1, P = 0.05). This implies that the sanitation facilities in Bidibidi refugee camp need to be redesigned and improved especially the pit latrines and the solid waste disposal facilities in order to meet the minimum Humanitarian Sphere Standards. Also, there should be more provision of taps with flowing water in the camp for effective washing practices to minimize the spread of sanitation-related diseases.

What is it about music that allows people to transcend difference? Can what we learn about music’s abilities inform an enhanced conversation of difference and be applied to the theory of education and critical pedagogy? These questions form the basis of my inquiry into music and social change, an investigation that I have largely focused in North America during the twentieth century. I had the opportunity to further this inquiry and explore the structural roots of music while participating in an adult education conference at the source of Nile in Uganda in the year 2004. The following personal narrative articulates my experiences in Africa and is an attempt to counter the dominant paternalistic hegemony often ascribed towards Africa and its people. In the course of actually losing my luggage, I became aware of Africa and the Africans I met as a place and people of generosity and discovery. In particular, I have been inspired by Africans’ writing both within the continent and in the Diaspora, continue to offer to both cultural studies theory and cultural practices. It is within the framework of cultural studies and human rights theory that I begin to identify a space in which music operates as a collective entity. By building north-south and east-west dialogues, working within and outside the academy, African intellectuals, activists, and artists continue to enrich our cultural landscape. My writing then, is an initial attempt to demonstrate the need to develop a more inclusive critical pedagogy that will benefit from the work of African scholarship and practice.

Abstract Background Literature shows a high prevalence of psychological distress (PD) as well as common mental disorders (CMD) such as major depressive disorders (MDD), generalized anxiety disorders (GAD), post-traumatic stress disorders (PTSD), and substance misuse disorders (SUD) among people exposed to disasters and pandemics like the COVID-19. Moreover, CMD are associated with increased mortality (mainly through suicide) and morbidity (loss of productivity). A number of countries have made deliberate efforts to identify and manage CMD in light of COVID-19. However, low levels of mental health literacy (MHL) manifested by the individual’s unawareness of CMD symptoms, limited human and mental health infrastructure resources, and high levels of mental illness stigma (MIS) are barriers to integration of mental health care in general health care during pandemics and epidemics such as the COVID-19. Objectives For the proposed study, we will determine effectiveness of a psycho-education intervention delivered by village health team (VHT) members. Methods We will employ a cluster randomized trial design in 24 villages in central Uganda. We will collect baseline data to and document the prevalence of MHL, PD, MDD, PTSD, GAD, and SUD. We will distribute information education and communication materials (IEC) aimed at improving MHL to 420 adult individuals in the intervention arm (n = 12 villages). In the control arm (n = 12 villages), VHTs will distribute ministry of health COVID-19 information leaflets to 420 participants. Within 7 days of distributing the materials, research assistants will conduct a follow-up interview and assess for the same parameters (MHL, PD, MDD, PTSD, GAD, and SUD). We will use an intention to treat analysis to estimate the effectiveness of the psycho-education intervention. Discussion Findings from this research will guide policy and practice regarding the integration of mental health services in the community in the context of epidemic preparedness and response. Trial registration ClinicalTrials.govNCT04616989. Registered on 05 November 2020

Abstract Background Female sex workers operating in conflict-affected settings could be at a much greater risk of major depression. However, the epidemiology of major depression in this population remains understudied. We aimed to determine the prevalence and the factors associated with major depression among FSWs in the post-conflict Gulu district in Northern Uganda. Methods We conducted a cross-sectional study among 300 randomly selected adult female sex workers in Gulu. We utilized a pre-tested semi-structured questionnaire, embedded with MINI 7.0.0, to gather information from each participant through face-to-face interviews. We collected data on socio-demographic characteristics, sex-work-related characteristics, alcohol and drug use, HIV status, and major depression. Then, data were entered into EPI INFO 7 and analyzed using logistic regression with the aid of STATA 14.0. Results The mean age (SD) of the study participants was 26.4 (± 6) years, 57.7% attained primary education, 51.7% never married, and 42.1% were living with HIV. The prevalence of major depression among FSWs in the district was 47.7%. In addition, the majority of the FSWs with major depression (91.0%) had either severe (50.4%) or moderate (40.6%) depressive symptoms. Independently, life stress (adjusted OR = 10.8, 95%CI: 5.67–20.57), living with HIV (adjusted OR = 2.25, 95%CI: 1.25–4.05), verbal abuse (adjusted OR = 2.27, 95%CI: 1.27–4.08), and older age (adjusted OR = 1.06, 95%CI: 1.01–1.12) all showed positive associations with major depression. Conversely, provision of sexual services from clients’ homes (adjusted OR = 0.50, 95%CI: 0.25–0.97), use of a non-barrier modern family planning method (adjusted OR = 0.44, 95%CI: 0.24–0.82), and daily intake of alcohol (adjusted OR = 0.50, 95%CI: 0.28–0.88) all showed negative associations with major depression. Conclusions There is a high prevalence of major depression among female sex workers in post-conflict Gulu. The high prevalence of major depression underscores the need for government and development partners to urgently and adequately address the mental health needs of female sex workers.

“Human beings are not born once and for all on the day their mothers give birth to them [...] life obliges them over and over again to give birth to themselves.” (Garcia Marquez 165) Introduction The refugee experience is, at heart, one of rebirth. Just as becoming a new, distinctive being—biological birth—necessarily involves the physical separation of mother and infant, so becoming a refugee entails separation from a "mother country." This mother country may or may not be a recognised nation state; the point is that the refugee transitions from physical connectedness to separation, from insider to outsider, from endemic to alien. Like babies, refugees may have little control over the timing and conditions of their expulsion. Successful resettlement requires not one rebirth but multiple rebirths—resettlement is a lifelong process (Layton)—which in turn require hope, imagination, and energy. In rebirthing themselves over and over again, people who have fled or been forced from their homelands become both mother and child. They do not go through this rebirthing alone. A range of agencies and individuals may be there to assist, including immigration officials, settlement services, schools and teachers, employment agencies and employers, English as a Second Language (ESL) resources and instructors, health-care providers, counsellors, diasporic networks, neighbours, church groups, and other community organisations. The nature, intensity, and duration of these “midwives’” interventions—and when they occur and in what combinations—vary hugely from place to place and from person to person, but there is clear evidence that post-migration experiences have a significant impact on settlement outcomes (Fozdar and Hartley). This paper draws on qualitative research I did in 2012 in a regional town in New South Wales to illuminate some of the ways in which settlement aides ease, or impede, refugees’ rebirth as fully recognised and participating Australians. I begin by considering what it means to be resilient before tracing some of the dimensions of the resettlement process. In doing so, I draw on data from interviews and focus groups with former refugees, service providers, and other residents of the town I shall call Easthaven. First, though, a word about Easthaven. As is the case in many rural and regional parts of Australia, Easthaven’s population is strongly dominated by Anglo Celtic and Saxon ancestries: 2011 Census data show that more than 80 per cent of residents were born in Australia (compared with a national figure of 69.8 per cent) and about 90 per cent speak only English at home (76.8 per cent). Almost twice as many people identify as Aboriginal or Torres Strait Islander as the national figure of 2.5 per cent (Australian Bureau of Statistics). For several years Easthaven has been an official “Refugee Welcome Zone”, welcoming hundreds of refugees from diverse countries in Africa and the Middle East as well as from Myanmar. This reflects the Department of Immigration and Citizenship’s drive to settle a fifth of Australia’s 13,750 humanitarian entrants a year directly in regional areas. In Easthaven’s schools—which is where I focused my research—almost all of the ESL students are from refugee backgrounds. Defining Resilience Much of the research on human resilience is grounded in psychology, with a capacity to “bounce back” from adverse experiences cited in many definitions of resilience (e.g. American Psychological Association). Bouncing back implies a relatively quick process, and a return to a state or form similar to that which existed before the encounter with adversity. Yet resilience often requires sustained effort and significant changes in identity. As Jerome Rugaruza, a former UNHCR refugee, says of his journey from the Democratic Republic of Congo to Australia: All the steps begin in the burning village: you run with nothing to eat, no clothes. You just go. Then you get to the refugee camp […] You have a little bread and you thank god you are safe. Then after a few years in the camp, you think about a future for your children. You arrive in Australia and then you learn a new language, you learn to drive. There are so many steps and not everyone can do it. (Milsom) Not everyone can do it, but a large majority do. Research by Graeme Hugo, for example, shows that although humanitarian settlers in Australia face substantial barriers to employment and initially have much higher unemployment rates than other immigrants, for most nationality groups this difference has disappeared by the second generation: “This is consistent with the sacrifice (or investment) of the first generation and the efforts extended to attain higher levels of education and English proficiency, thereby reducing the barriers over time.” (Hugo 35). Ingrid Poulson writes that “resilience is not just about bouncing. Bouncing […] is only a reaction. Resilience is about rising—you rise above it, you rise to the occasion, you rise to the challenge. Rising is an active choice” (47; my emphasis) I see resilience as involving mental and physical grit, coupled with creativity, aspiration and, crucially, agency. Dimensions of Resettlement To return to the story of 41-year-old Jerome Rugaruza, as related in a recent newspaper article: He [Mr Rugaruza] describes the experience of being a newly arrived refugee as being like that of a newborn baby. “You need special care; you have to learn to speak [English], eat the different food, create relationships, connections”. (Milsom) This is a key dimension of resettlement: the adult becomes like an infant again, shifting from someone who knows how things work and how to get by to someone who is likely to be, for a while, dependent on others for even the most basic things—communication, food, shelter, clothing, and social contact. The “special care” that most refugee arrivals need initially (and sometimes for a long time) often results in their being seen as deficient—in knowledge, skills, dispositions, and capacities as well as material goods (Keddie; Uptin, Wright and Harwood). As Fozdar and Hartley note: “The tendency to use a deficit model in refugee resettlement devalues people and reinforces the view of the mainstream population that refugees are a liability” (27). Yet unlike newborns, humanitarian settlers come to their new countries with rich social networks and extensive histories of experience and learning—resources that are in fact vital to their rebirth. Sisay (all names are pseudonyms), a year 11 student of Ethiopian heritage who was born in Kenya, told me with feeling: I had a life back in Africa [her emphasis]. It was good. Well, I would go back there if there’s no problems, which—is a fact. And I came here for a better life—yeah, I have a better life, there’s good health care, free school, and good environment and all that. But what’s that without friends? A fellow student, Celine, who came to Australia five years ago from Burundi via Uganda, told me in a focus group: Some teachers are really good but I think some other teachers could be a little bit more encouraging and understanding of what we’ve gone through, because [they] just look at you like “You’re year 11 now, you should know this” […] It’s really discouraging when [the teachers say] in front of the class, “Oh, you shouldn’t do this subject because you haven’t done this this this this” […] It’s like they’re on purpose to tell you “you don’t have what it takes; just give up and do something else.” As Uptin, Wright and Harwood note, “schools not only have the power to position who is included in schooling (in culture and pedagogy) but also have the power to determine whether there is room and appreciation for diversity” (126). Both Sisay and Celine were disheartened by the fact they felt some of their teachers, and many of their peers, had little interest in or understanding of their lives before they came to Australia. The teachers’ low expectations of refugee-background students (Keddie, Uptin, Wright and Harwood) contrasted with the students’ and their families’ high expectations of themselves (Brown, Miller and Mitchell; Harris and Marlowe). When I asked Sisay about her post-school ambitions, she said: “I have a good idea of my future […] write a documentary. And I’m working on it.” Celine’s response was: “I know I’m gonna do medicine, be a doctor.” A third girl, Lily, who came to Australia from Myanmar three years ago, told me she wanted to be an accountant and had studied accounting at the local TAFE last year. Joseph, a father of three who resettled from South Sudan seven years ago, stressed how important getting a job was to successful settlement: [But] you have to get a certificate first to get a job. Even the job of cleaning—when I came here I was told that somebody has to go to have training in cleaning, to use the different chemicals to clean the ground and all that. But that is just sweeping and cleaning with water—you don’t need the [higher-level] skills. Simple jobs like this, we are not able to get them. In regional Australia, employment opportunities tend to be limited (Fozdar and Hartley); the unemployment rate in Easthaven is twice the national average. Opportunities to study are also more limited than in urban centres, and would-be students are not always eligible for financial assistance to gain or upgrade qualifications. Even when people do have appropriate qualifications, work experience, and language proficiency, the colour of their skin may still mean they miss out on a job. Tilbury and Colic-Peisker have documented the various ways in which employers deflect responsibility for racial discrimination, including the “common” strategy (658) of arguing that while the employer or organisation is not prejudiced, they have to discriminate because of their clients’ needs or expectations. I heard this strategy deployed in an interview with a local businesswoman, Catriona: We were advertising for a new technician. And one of the African refugees came to us and he’d had a lot of IT experience. And this is awful, but we felt we couldn't give him the job, because we send our technicians into people's houses, and we knew that if a black African guy rocked up at someone’s house to try and fix their computer, they would not always be welcomed in all—look, it would not be something that [Easthaven] was ready for yet. Colic-Peisker and Tilbury (Refugees and Employment) note that while Australia has strict anti-discrimination legislation, this legislation may be of little use to the people who, because of the way they look and sound (skin colour, dress, accent), are most likely to face prejudice and discrimination. The researchers found that perceived discrimination in the labour market affected humanitarian settlers’ sense of satisfaction with their new lives far more than, for example, racist remarks, which were generally shrugged off; the students I interviewed spoke of racism as “expected,” but “quite rare.” Most of the people Colic-Peisker and Tilbury surveyed reported finding Australians “friendly and accepting” (33). Even if there is no active discrimination on the basis of skin colour in employment, education, or housing, or overt racism in social situations, visible difference can still affect a person’s sense of belonging, as Joseph recounts: I think of myself as Australian, but my colour doesn’t [laughs] […] Unfortunately many, many Australians are expecting that Australia is a country of Europeans … There is no need for somebody to ask “Where do you come from?” and “Do you find Australia here safe?” and “Do you enjoy it?” Those kind of questions doesn’t encourage that we are together. This highlights another dimension of resettlement: the journey from feeling “at home” to feeling “foreign” to, eventually, feeling at home again in the host country (Colic-Peisker and Tilbury, Refugees and Employment). In the case of visibly different settlers, however, this last stage may never be completed. Whether the questions asked of Joseph are well intentioned or not, their effect may be the same: they position him as a “forever foreigner” (Park). A further dimension of resettlement—one already touched on—is the degree to which humanitarian settlers actively manage their “rebirth,” and are allowed and encouraged to do so. A key factor will be their mastery of English, and Easthaven’s ESL teachers are thus pivotal in the resettlement process. There is little doubt that many of these teachers have gone to great lengths to help this cohort of students, not only in terms of language acquisition but also social inclusion. However, in some cases what is initially supportive can, with time, begin to undermine refugees’ maturity into independent citizens. Sharon, an ESL teacher at one of the schools, told me how she and her colleagues would give their refugee-background students lifts to social events: But then maybe three years down the track they have a car and their dad can drive, but they still won’t take them […] We arrive to pick them up and they’re not ready, or there’s five fantastic cars in the driveway, and you pick up the student and they say “My dad’s car’s much bigger and better than yours” [laughs]. So there’s an expectation that we’ll do stuff for them, but we’ve created that [my emphasis]. Other support services may have more complex interests in keeping refugee settlers dependent. The more clients an agency has, the more services it provides, and the longer clients stay on its books, the more lucrative the contract for the agency. Thus financial and employment imperatives promote competition rather than collaboration between service providers (Fozdar and Hartley; Sidhu and Taylor) and may encourage assumptions about what sorts of services different individuals and groups want and need. Colic-Peisker and Tilbury (“‘Active’ and ‘Passive’ Resettlement”) have developed a typology of resettlement styles—“achievers,” “consumers,” “endurers,” and “victims”—but stress that a person’s style, while influenced by personality and pre-migration factors, is also shaped by the institutions and individuals they come into contact with: “The structure of settlement and welfare services may produce a victim mentality, leaving members of refugee communities inert and unable to see themselves as agents of change” (76). The prevailing narrative of “the traumatised refugee” is a key aspect of this dynamic (Colic-Peisker and Tilbury, “‘Active’ and ‘Passive’ Resettlement”; Fozdar and Hartley; Keddie). Service providers may make assumptions about what humanitarian settlers have gone through before arriving in Australia, how they have been affected by their experiences, and what must be done to “fix” them. Norah, a long-time caseworker, told me: I think you get some [providers] who go, “How could you have gone through something like that and not suffered? There must be—you must have to talk about this stuff” […] Where some [refugees] just come with the [attitude] “We’re all born into a situation; that was my situation, but I’m here now and now my focus is this.” She cited failure to consider cultural sensitivities around mental illness and to recognise that stress and anxiety during early resettlement are normal (Tilbury) as other problems in the sector: [Newly arrived refugees] go through the “happy to be here” [phase] and now “hang on, I’ve thumped to the bottom and I’m missing my own foods and smells and cultures and experiences”. I think sometimes we’re just too quick to try and slot people into a box. One factor that appears to be vital in fostering and sustaining resilience is social connection. Norah said her clients were “very good on the mobile phone” and had links “everywhere,” including to family and friends in their countries of birth, transition countries, and other parts of Australia. A 2011 report for DIAC, Settlement Outcomes of New Arrivals, found that humanitarian entrants to Australia were significantly more likely to be members of cultural and/or religious groups than other categories of immigrants (Australian Survey Research). I found many examples of efforts to build both bonding and bridging capital (Putnam) in Easthaven, and I offer two examples below. Several people told me about a dinner-dance that had been held a few weeks before one of my visits. The event was organised by an African women’s group, which had been formed—with funding assistance—several years before. The dinner-dance was advertised in the local newspaper and attracted strong interest from a broad cross-section of Easthaveners. To Debbie, a counsellor, the response signified a “real turnaround” in community relations and was a big boon to the women’s sense of belonging. Erica, a teacher, told me about a cultural exchange day she had organised between her bush school—where almost all of the children are Anglo Australian—and ESL students from one of the town schools: At the start of the day, my kids were looking at [the refugee-background students] and they were scared, they were saying to me, "I feel scared." And we shoved them all into this tiny little room […] and they had no choice but to sit practically on top of each other. And by the end of the day, they were hugging each other and braiding their hair and jumping and playing together. Like Uptin, Wright and Harwood, I found that the refugee-background students placed great importance on the social aspects of school. Sisay, the girl I introduced earlier in this paper, said: “It’s just all about friendship and someone to be there for you […] We try to be friends with them [the non-refugee students] sometimes but sometimes it just seems they don’t want it.” Conclusion A 2012 report on refugee settlement services in NSW concludes that the state “is not meeting its responsibility to humanitarian entrants as well as it could” (Audit Office of New South Wales 2); moreover, humanitarian settlers in NSW are doing less well on indicators such as housing and health than humanitarian settlers in other states (3). Evaluating the effectiveness of formal refugee-centred programs was not part of my research and is beyond the scope of this paper. Rather, I have sought to reveal some of the ways in which the attitudes, assumptions, and everyday practices of service providers and members of the broader community impact on refugees' settlement experience. 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