Journal articles on the topic 'Mate selection – Uganda – Kampala'

Most patients failing antiretroviral treatment in Uganda continue to fail their treatment regimen even if a dominant drug-resistant HIV-1 genotype is not detected. In a recent retrospective study, we observed that approximately 30% of HIV-infected individuals in the Joint Clinical Research Centre (Kampala, Uganda) experienced virologic failure with a susceptible HIV-1 genotype based on standard Sanger sequencing. Selection of minority drug-resistant HIV-1 variants (not detectable by Sanger sequencing) under antiretroviral therapy pressure can lead to a shift in the viral quasispecies distribution, becoming dominant members of the virus population and eventually causing treatment failure. Here, we used a novel HIV-1 genotyping assay based on deep sequencing (DeepGen) to quantify low-level drug-resistant HIV-1 variants in 33 patients failing a first-line antiretroviral treatment regimen in the absence of drug-resistant mutations, as screened by standard population-based Sanger sequencing. Using this sensitive assay, we observed that 64% (21/33) of these individuals had low-frequency (or minority) drug-resistant variants in the intrapatient HIV-1 population, which correlated with treatment failure. Moreover, the presence of these minority HIV-1 variants was associated with higher intrapatient HIV-1 diversity, suggesting a dynamic selection or fading of drug-resistant HIV-1 variants from the viral quasispecies in the presence or absence of drug pressure, respectively. This study identified low-frequency HIV drug resistance mutations by deep sequencing in Ugandan patients failing antiretroviral treatment but lacking dominant drug resistance mutations as determined by Sanger sequencing methods. We showed that these low-abundance drug-resistant viruses could have significant consequences for clinical outcomes, especially if treatment is not modified based on a susceptible HIV-1 genotype by Sanger sequencing. Therefore, we propose to make clinical decisions using more sensitive methods to detect minority HIV-1 variants.

Purpose The purpose of this paper is to report the training of college librarians, academic and management staff, IT managers and students on how to organise, manage and use a user-friendly library. In Uganda, as in many countries, the problem is that school and/or college libraries are managed by librarians who may have good cataloguing and management skills, but who do not have the pedagogic skills and knowledge of the school curricula that are necessary for librarians to be able to guide and mentor both teachers and students or organise curriculum-related activities or facilitate research. The development of user-friendly libraries contributes in improving education quality through nurturing the interest of students and teachers in literacy activities and active search for knowledge. Under the stewardship of the Belgium Technical Cooperation and the Ministry of Education in Uganda, library stakeholders were trained on how to put users – rather than themselves – in the centre of the library’s operations and introduced to active teaching and learning methodologies and activities with emphasis on getting engaged in transforming spaces, services, outreach to users and collections. Several measures, short and long term were taken to address the gaps limiting the performance of the librarians. Given the disparities in the trainees’ education level and work experience, the training was delivered in seven modules divided into three units for over eight months in 2015. By the end of the training, trainees developed unique library strategic plan, library policies and procedures, capacity to use library systems, physical design and maintenance systems, partnerships, library structure and staff job descriptions. Design/methodology/approach To effectively engage the participants each topic was conducted using active teaching and learning (ATL) methodologies, including: lecture with slides and hands-on practice – each topic was introduced in a lecture form with slides and hands-on exercises. The main goal was to introduce the participants to the concepts discussed, offer opportunities to explore alternative approaches, as well define boundaries for discussion through brainstorming. The question-answer approach kept the participants alert and to start thinking critically on the topic discussed – brainstorming sessions allowed thinking beyond the presentation room, drawing from personal experiences to provide alternatives to anticipated challenges. The goal here was for the participants to provide individual choices and approaches for real life problems; group discussions: case study/ scenario and participant presentations – participants were provided with a scenario and asked to provide alternative approaches that could solve the problem based on their personal experience at their colleges. By the end of the group discussion, participants presented a draft of the deliverable as per the topic under discussion. More so, group discussions were an excellent approach to test participant’s teamwork skills and ability to compromise, as well as respecting team decisions. It was an opportunity to see how librarians will work with the library committees. Group discussions further initiated and cemented the much-needed librarian–academic staff – college management relationship. During the group discussion, librarians, teaching staff, ICT staff and college management staff, specifically the Principals and Deputy Principals interacted freely thus starting and cultivating a new era of work relationship between them. Individual presentation: prior to the workshop, participants were sent instructions to prepare a presentation on a topic. For example, participants were asked to provide their views of what a “user-friendly library” would look like or what would constitute a “user-friendly library”; the college library of HTC-Mulago was asked to talk about their experience working with book reserves, challenges faced and plans they have to address the challenges, while the college librarian from NTC-Kaliro was asked to describe a situation where they were able to assist a patron, the limitations they faced and how they addressed them. Doing so did not only assist to emotionally prepare the participants for the training but also helped to make them start thinking about the training in relation to their libraries and work. Take-home assignment: at the end of each session, participants were given home assignments to not only revise the training material but also prepare for the next day training. Further the take-home assignments provided time for the participants to discuss with their colleagues outside of the training room so as to have a common ground/ understanding on some of the very sensitive issues. Most interesting assignment was when participants were asked to review an article and to make a presentation in relation to their library experiences. Participant reports: participant reports resulted from the take-home assignments and participants were asked to make submission on a given topic. For example, participants were asked to review IFLA section on library management and write a two-page report on how such information provided supported their own work, as well as a participant report came from their own observation after a library visit. Invited talks with library expert: two invited talks by library experts from Consortium of Uganda University Libraries and Uganda Library and Information Science Association with the goal to share their experience, motivate the participants to strive higher and achieve great things for their libraries. Library visitation: there were two library visits conducted on three separate days – International Hospital Kampala (IHK) Library, Makerere University Library and Aga Khan University Hospital Library. Each of these library visits provided unique opportunities for the participants to explore best practices and implement similar practices in their libraries. Visual aids – videos, building plans and still photos: these were visual learning aids to supplement text during the lectures because they carried lot of information while initiating different thoughts best on the participants’ past experience and expertise. The training advocated for the use of ATL methodologies and likewise similar methodologies were used to encourage participants do so in their classrooms. Findings Addressing Key Concerns: Several measures, both long and short term, were taken to address the gaps limiting the performance of the librarians. The measures taken included: selected representative sample of participants including all college stakeholders as discussed above; active teaching and learning methodologies applied in the training and blended in the content of the training materials; initiated and formulated approaches to collaborations, networks and partnerships; visited different libraries to benchmark library practices and encourage future job shadowing opportunities; and encouraged participants to relate freely, understand and value each other’s work to change their mindsets. College librarians were encouraged to ensure library priorities remain on the agenda through advocacy campaigns. Short-term measures: The UFL training was designed as a practical and hands-on training blended with individual and group tasks, discussions, take-home assignments and presentations by participants. This allowed participates to engage with the material and take responsibility for their own work. Further, the training material was prepared with a view that librarians support the academic life of teaching staff and students. Participants were tasked to develop and later fine-tune materials designed to support their work. For example, developing a subject bibliography and posting it on the library website designed using open source tools such as Google website, Wikis, blogs. The developed library manual includes user-friendly policies and procedures referred to as “dos and don’ts in the library” that promote equitable open access to information; drafting book selection memos; new book arrivals lists; subscribing to open access journals; current awareness services and selective dissemination of information service displays and electronic bulletins. Based on their library needs and semester calendar, participants developed action points and timelines to implement tasks in their libraries at the end of each unit training. Librarians were encouraged to share their experiences through library websites, Facebook page, group e-mail/listserv and Instagram; however, they were challenged with intimate internet access. College libraries were rewarded for their extraordinary job. Given their pivotal role in the management and administration of financial and material resources, on top of librarians, the participants in this training were college administrators/ management, teaching and ICT staff, researchers and student leadership. Participants were selected to address the current and future needs of the college library. These are individuals that are perceived to have a great impact towards furthering the college library agenda. The practical nature of this training warranted conducting the workshops from developed but similar library spaces, for example, Aga Khan University Library and Kampala Capital City, Makerere University Library, International Hospital Kampala Library and Uganda Christian University Library. Participants observed orientation sessions, reference desk management and interviews, collection management practices, preservation and conservation, secretarial bureau management, etc. Long-term measures: Changing the mindset of librarians, college administrators and teaching staff is a long-term commitment which continues to demand for innovative interventions. For example: job shadowing allowed college librarian short-term attachments to Makerere University Library, Uganda Christian University Library, Aga Khan Hospital University Library and International Hospital Kampala Library – these libraries were selected because of their comparable practices and size. The mentorship programme lasted between two-three weeks; on-spot supervision and follow-up visits to assess progress with the action plan by the librarians and college administration and college library committee; ensuring that all library documents – library strategic plan, library manual, library organogram, etc are approved by the College Governing Council and are part of the college wide governing documents; and establishing the library committee with a job description for each member – this has strengthened the library most especially as an advocacy tool, planning and budgeting mechanism, awareness channel for library practices, while bringing the library to the agenda – reemphasizing the library’s agenda. To bridge the widened gap between librarians and the rest of the stakeholders, i.e. teaching staff, ICT staff, college administration and students, a college library committee structure and its mandate were established comprising: Library Committee Chairperson – member of the teaching staff; Library Committee Secretary – College Librarian; Student Representative – must be a member of the student Guild with library work experience; and Representative from each college academic department. A library consortium was formed involving all the four project supported colleges to participate in resource sharing practices, shared work practices like shared cataloguing, information literacy training, reference interview and referral services as well a platform for sharing experiences. A library consortium further demanded for automating library functions to facilitate collaboration and shared work. Plans are in place to install Koha integrated library system that will cultivate a strong working relationship between librarians and students, academic staff, college administration and IT managers. This was achieved by ensuring that librarians innovatively implement library practices and skills acquired from the workshop as well as show their relevance to the academic life of the academic staff. Cultivating relationships takes a great deal of time, thus college librarians were coached on: creating inclusive library committees, timely response to user needs, design library programmes that address user needs, keeping with changing technology to suite changing user needs, seeking customer feedback and collecting user statistics to support their requests, strengthening the library’s financial based by starting a secretarial bureau and conducting user surveys to understand users’ information-seeking behaviour. To improve the awareness of new developments in the library world, college librarians were introduced to library networks at national, regional and international levels, as a result they participated in conferences, workshops, seminars at local, regional and international level. For example, for the first time and with funding from Belgium Technical Cooperation, college librarians attended 81st IFLA World Library and Information Congress in South African in 2015. College libraries are now members of the Consortium of Uganda University Libraries and Uganda Library and Information Science Association and have attended meetings of these two very important library organisations in Uganda’s LIS profession. The college librarians have attended meetings and workshops organized by these two organisations. Originality/value At the end of the three units training, participants were able to develop: a strategic plan for their libraries; an organogram with staffing needs and job description matching staff functions; a Library Committee for each library and with a structure unifying all the four project-support Colleges; a library action plan with due dates including deliverables and responsibilities for implementation; workflow plan and organisation of key sections of the library such as reserved and public spaces; furniture and equipment inventory (assets); a library manual and collection development policy; partnerships with KCCA Library and Consortium of Uganda University Libraries; skills to use Koha ILMS for performing library functions including: cataloguing, circulation, acquisitions, serials management, reporting and statistics; skills in searching library databases and information literacy skills; skills in designing simple and intuitive websites using Google Sites tools; and improved working relationship between the stakeholders was visible. To further the user-friendly libraries principle of putting users in the centre of the library’s operations, support ATL methodologies and activities with emphasis on getting engaged in transforming spaces, services, outreach to users and collections the following initiatives are currently implemented in the colleges: getting approval of all library policy documents by College Governing Council, initiating job shadowing opportunities, conducting on-spot supervision, guide libraries to set up college library committees and their job description, design library websites, develop dissemination sessions for all library policies, incorporate user-friendly language in all library documents, initiate income generation activities for libraries, set terms of reference for library staff and staffing as per college organogram, procurement of library tools like DDC and library of congress subject headings (LCSH), encourage attendance to webinars and space planning for the new libraries.

The objective of this study was to evaluate whether relationship exist between credit risk management techniques and financial performance of microfinance institutions in Kampala, Uganda. Specifically, the study examined whether there is a relationship between credit risk identification, credit risk appraisal, credit risk monitoring, credit risk mitigation and financial performance of microfinance institutions in Kampala using sample of 60 members of staff in finance and credit departments of three licensed microfinance institutions in Kampala, Uganda namely Finca Uganda Ltd, Pride Microfinance Ltd, UGAFODE Microfinance Ltd. Primary data was collected using questionnaires and it comprised of closed ended questions. Secondary data was collected from the microfinance institutions (MDI’s) annual reports (2011 - 2015). Frequencies and descriptive statistics were used to analyse the population. Pearson linear correlation coefficient was adopted to examine relationship between credit risk management techniques and financial performance. The findings indicate that credit risk identification and credit risk appraisal has a strong positive relationship on financial performance of MDIs, while credit risk monitoring and credit risk mitigation have moderate significant positive relationship on financial performance of MDIs. The study recommends, among others, that the credit risk appraisal process should identify and analyse all loss exposures, and measure such loss exposures. This should guide in selection of technique or combination of techniques to handle each exposure. The study concludes that MDIs should continually emphasise effective credit risk identification, credit risk appraisal, credit risk monitoring, and credit risk mitigation techniques to enhance maximum financial performance.

A survey was conducted at Wambizi slaughterhouse in Kampala City, Uganda, to ascertain the prevalence of Taenia species infection in pigs via serology, as well as the role of meat inspection in control of these parasitic conditions in carcasses of slaughtered pigs. A total of 620 pigs were sampled using simple random selection during three months. Individual pig data including sex, breed, district of origin, antemortem clinical signs and postmortem lesions were recorded. Blood samples were collected for serological assays. A questionnaire was used to capture perceptions of meat inspectors and pig traders on T. solium cysticercosis. Of the 620 pig inspected carcasses, only four were observed with T. solium cysts and none had T. hydatigena cysts. Up to 67 (10.8%) pigs tested positive by B158C11A10/B60H8A4 Ag-ELISA serology. Seroprevalences were significantly different between districts (χ2 = 45.98; p < 0.001) with pigs from the Eastern districts having the highest seroprevalence. The two meat inspectors at the slaughterhouse had knowledge of pork inspection protocol for Taenia spp. infections, although they did not follow it properly because of the high number of carcasses to be inspected daily. All the 15 traders interviewed had heard about porcine cysticercosis but only five had ever seen cystic pork. T. solium cysticercosis is still prevailing in pigs in Uganda. Meat inspection is not a reliable diagnostic tool for efficient detection of T. solium cysticercosis.

Abstract The endemic form of Burkitt lymphoma (eBL), the most common pediatric cancer in sub-Saharan Africa, is the prototypic infection-related malignancy. Virtually 100% of eBL tumor cells carry Epstein-Barr virus (EBV) DNA, and eBL is closely ecologically associated with holoendemic P. falciparum malaria. The cell that undergoes transformation in eBL is an antigen-experienced B lymphocyte that has reached the germinal center and initiated the process of somatic hypermutation (SHM). The tumor cells in eBL express functional B-cell antigen receptors (BCRs), most commonly of the IgM isotype. The rearranged immunoglobulin heavy (IGH) and light (IGκ/λ) chain genes that encode Burkitt BCRs show evidence of SHM, demonstrating that eBL cells have uncoupled the processes of class switch recombination and SHM. Several lines of evidence suggest that BCR signaling pathways are active in eBL cells and that BCR signaling may contribute to the pathogenesis and maintenance of the disease. The uniquely rearranged BCR genes in eBL also represent a tumor-specific molecular signature that can be used to detect and quantitate eBL tumor cells in different tissue compartments. Therefore, Burkitt-associated BCRs have potential as both a disease biomarker and a therapeutic target. We utilized next-generation sequencing (NGS) to identify BCR gene rearrangements in eBL tumor cells obtained at the time of diagnosis from 22 patients, ages 4 to 12 (median: 7 years), with histologically confirmed Burkitt lymphoma who presented to the Uganda Cancer Institute in Kampala, Uganda. Thirteen of the patients were male and 9 were female; 3 patients were HIV-positive. Genomic DNA was isolated from cryopreserved tumor biopsies, and NGS of the IGH and IGκ/λ loci was performed to identify dominant BCR rearrangements in the eBL tumor cells. Sequence reads spanned a 130-nucleotide interval from the middle of framework region 3 (FR3) in the V gene segment to the 5’ region of the J gene segment. The reads captured the entirety of the CDR3 region. A single dominant IGH V-D-J rearrangement comprising >35% of all sequence reads was identified in 16 of the 22 samples. A single dominant IGκ or IGλ rearrangement was likewise seen in most cases with a single dominant IGH rearrangement. Two dominant but independent light chain rearrangements were seen in three eBL cases with a single dominant IGH rearrangement; whether both productive light chains are expressed at the RNA level is under active investigation. The utilization of IGH V- and J-gene segments in Burkitt-associated BCRs from this cohort of 22 patients was highly non-uniform, with utilization of IGHJ04-01 observed in 10 of the 16 cases with a single dominant IGH rearrangement. Analysis of BCR SHM patterns has revealed enrichment in CDRs as compared to FRs, suggesting antigen selection in eBL tumor cells, as well as a higher than expected rate of somatic mutations that create potential N-linked glycosylation sites. Deep sequencing of DNA extracted from peripheral blood mononuclear cells (PBMC) obtained at the time of diagnosis from 13 of the 22 patients identified sequences that were identical to the dominant IGH sequences observed in each patient’s tumor in 9 cases (69%). 5 of the 9 patients had early stage (Ziegler A) disease, demonstrating that Burkitt lymphoma cells commonly circulate in the blood. Current studies include sequencing of rearranged IGH genes present in PBMC after completion of primary therapy to determine if response is correlated with disappearance of the putative tumor-associated BCR sequences. Each eBL tumor sample is undergoing RNA analysis to confirm expression of the established dominant IGH and IGκ/λ rearrangements, as well as to determine the dominant BCR isotype. The complete light and heavy chain variable region sequences of the tumor-associated BCRs are being cloned by PCR with V gene leader peptide- and CDR3-specific primers to enable comprehensive assessment of SHM and BCR stereotypy. Identification of complete variable region sequences will also lay the foundation for synthesis of recombinant full-length membrane-associated and soluble forms of Burkitt BCRs. Reconstitution of Burkitt BCRs in vitro will allow evaluation of their antigenic specificity and signaling properties. Disclosures No relevant conflicts of interest to declare.

A large and growing literature links high levels of ethnic diversity to low levels of public goods provision. Yet although the empirical connection between ethnic heterogeneity and the underprovision of public goods is widely accepted, there is little consensus on the specific mechanisms through which this relationship operates. We identify three families of mechanisms that link diversity to public goods provision—what we term “preferences,” “technology,” and “strategy selection” mechanisms—and run a series of experimental games that permit us to compare the explanatory power of distinct mechanisms within each of these three families. Results from games conducted with a random sample of 300 subjects from a slum neighborhood of Kampala, Uganda, suggest that successful public goods provision in homogenous ethnic communities can be attributed to a strategy selection mechanism: in similar settings, co-ethnics play cooperative equilibria, whereas non-co-ethnics do not. In addition, we find evidence for a technology mechanism: co-ethnics are more closely linked on social networks and thus plausibly better able to support cooperation through the threat of social sanction. We find no evidence for prominent preference mechanisms that emphasize the commonality of tastes within ethnic groups or a greater degree of altruism toward co-ethnics, and only weak evidence for technology mechanisms that focus on the impact of shared ethnicity on the productivity of teams.

ABSTRACT We have recently reported an increased heterogeneity in the human immunodeficiency virus type 1 (HIV-1) envelope gene (env) in HIV-1-infected patients with pulmonary tuberculosis (TB) compared to patients with HIV-1 alone. This increase may be a result of dissemination of lung-derived HIV-1 isolates from sites of Mycobacterium tuberculosis infection and/or the systemic activation of the immune system in response to TB. To distinguish between these two mechanisms, blood and pleural fluid samples were obtained from HIV-1-infected patients with active pleural TB in Kampala, Uganda (CD4 cell counts of 34 to 705 cells/μl, HIV-1 plasma loads of 2,400 to 280,000 RNA copies/ml, and HIV-1 pleural loads of 7,600 to 4,500,000 RNA copies/ml). The C2-C3 coding region of HIV-1 env was PCR amplified from lysed peripheral blood mononuclear cells and pleural fluid mononuclear cells and reverse transcriptase-PCR amplified from plasma and pleural fluid HIV-1 virions of eight HIV-1 patients with pleural TB. Phylogenetic and phenetic analyses revealed a compartmentalization of HIV-1 quasispecies between blood and pleural space in four of eight patients, with migration events between the compartments. There was a trend for a greater genetic heterogeneity in the pleural space, which may be the result of an M. tuberculosis-mediated increase in HIV-1 replication and/or selection pressure at the site of infection. Collectively, these findings suggest that HIV-1 quasispecies in the M. tuberculosis-infected pleural space may leak into the systemic circulation and lead to increased systemic HIV-1 heterogeneity during TB.

Abstract Introduction Uganda is in discussions to introduce a national health insurance scheme. However, there is a paucity of information on household preferences and willingness to pay for health insurance attributes that may guide the design of an acceptable health insurance scheme. Our study sought to assess household preferences and willingness to pay for health insurance in Kampala city using a discrete choice experiment. Methods This study was conducted from 16th February 2020 to 10th April 2020 on 240 households in the Kawempe division of Kampala city stratified into slum and non-slum communities in order to get a representative sample of the area. We purposively selected the communities that represented slum and non-slum communities and thereafter applied systematic sampling in the selection of the households that participated in the study from each of the communities. Four household and policy-relevant attributes were used in the experimental design of the study. Each respondent attended to 9 binary choice sets of health insurance plans that included one fixed choice set. Data were analyzed using mixed logit models. Results Households in both the non-slum and slum communities had a high preference for health insurance plans that included both private and public health care providers as compared to plans that included public health care providers only (non-slum coefficient β = 0.81, P < 0.05; slum β = 0.87, p < 0.05) and; health insurance plans that covered extended family members as compared to plans that had limitations on the number of family members allowed (non-slum β = 0.44, P < 0.05; slum β = 0.36, p < 0.05). Households in non-slum communities, in particular, had a high preference for health insurance plans that covered chronic illnesses and major surgeries to other plans (0.97 β, P < 0.05). Our findings suggest that location of the household influences willingness to pay with households from non-slum communities willing to pay more for the preferred attributes. Conclusion Potential health insurance schemes should consider including both private and public health care providers and allow more household members to be enrolled in both slum and non-slum communities. However, the inclusion of more HH members should be weighed against the possible depletion of resources and other attributes. Potential health insurance schemes should also prioritize coverage for chronic illnesses and major surgeries in non-slum communities, in particular, to make the scheme attractive and acceptable for these communities.

Public procurement regulations in Uganda were initiated among other objectives; to ensure accountability, transparency and value for money in all public procurement activities. Despite the presence and application of these regulations, State Owned Enterprises have continued to face challenges in contracting for works, goods and services. Evidence shows that most procurement contracts are never fulfilled because of mal practices and high transaction costs. This study sought to examine whether contracting impacted behavioural practices in procurement performance of Uganda’s State Owned Enterprises. The study mainly employed quantitative research methods, in the process of research instrument design, data collection, analysis and presentation. The study sample consisted of 160 employees picked from 20 State Owned Enterprises in Kampala and Entebbe districts of Uganda. Data was collected through a self-administered questionnaire, sorted and analyzed using both descriptive and inferential statistics. Results reveal a positive and significant relationship exists between contracting and behavioural practices (r =.353**, p<.01). Further, the regression model indicates that contracting significantly predicts Behavioural practices in State Owned Enterprises (Beta=.763, Sig. =.000). For improved performance, State Owned Enterprises should clearly set their contract objectives to guide all those involved in the contracting process. There should be key deliverables in those objectives, which should be communicated to the relevant stakeholders. Further, staff on the contracting team should be selected on merit. This is very important in order to avoid biased selection of contracting teams – even when some of these people do not have the required experience and expertise. This is very important because service providers can exploit such a team to their benefit once they realize that the team is weak and vulnerable.

Abstract Background Between January 2015 and July 2017, we investigated the frequency of carbapenem resistant Acinetobacter baumannii (CRAB) and carbapenem resistant Pseudomonas aeruginosa (CRPA) at the Mulago Hospital intensive care unit (ICU) in Kampala, Uganda. Carbapenemase production and carbapenemase gene carriage among CRAB and CRPA were determined; mobility potential of carbapenemase genes via horizontal gene transfer processes was also studied. Methods Clinical specimens from 9269 patients were processed for isolation of CRAB and CRPA. Drug susceptibility testing was performed with the disk diffusion method. Carriage of carbapenemase genes and class 1 integrons was determined by PCR. Conjugation experiments that involved blaVIM positive CRAB/CRPA (donors) and sodium azide resistant Escherichia coli J53 (recipient) were performed. Results The 9269 specimens processed yielded 1077 and 488 isolates of Acinetobacter baumannii and Pseudomonas aeruginosa, respectively. Of these, 2.7% (29/1077) and 7.4% (36/488) were confirmed to be CRAB and CRPA respectively, but 46 were available for analysis (21 CRAB and 25 CRPA). Majority of specimens yielding CRAB and CRPA were from the ICU (78%) while 20 and 2% were from the ENT (Ear Nose & Throat) Department and the Burns Unit, respectively. Carbapenemase assays performed with the MHT assay showed that 40 and 33% of CRPA and CRAB isolates respectively, were carbapenemase producers. Also, 72 and 48% of CRPA and CRAB isolates respectively, were metallo-beta-lactamase producers. All the carbapenemase producing isolates were multidrug resistant but susceptible to colistin. blaVIM was the most prevalent carbapenemase gene, and it was detected in all CRAB and CRPA isolates while blaOXA-23 and blaOXA-24 were detected in 29 and 24% of CRAB isolates, respectively. Co-carriage of blaOXA-23 and blaOXA-24 occurred in 14% of CRAB isolates. Moreover, 63% of the study isolates carried class 1 integrons; of these 31% successfully transferred blaVIM to E. coli J53. Conclusions CRAB and CRPA prevalence at the Mulago Hospital ICU is relatively low but carbapenemase genes especially blaVIM and blaOXA-23 are prevalent among them. This requires strengthening of infection control practices to curb selection and transmission of these strains in the hospital.

PurposeSeveral intergovernmental organizations claim that the involvement of women in public procurement has a direct impact on sustainable development and growth, especially in the developing world, yet we know very little of such claim. This study aims to empirically examine how public procurement can contribute to women empowerment by boosting the competitiveness of women-owned businesses (WOBs) in Uganda.Design/methodology/approachIn this study, a cross-sectional survey method is used. Quantitative data were gathered from a sample of 371 respondents in Ministries, Departments and Agencies (MDAs) and a section of women entrepreneurs in Uganda's capital Kampala. From the literature review, six hypotheses were formulated and tested using structural equation modelling (SEM). A research model is developed and presented.FindingsAll hypotheses, except for one, were supported. Procurement policy had a significant influence on evaluation criteria, contract management and most importantly, on the competitiveness of WOBs. Within the procurement process, evaluation criteria had a significant influence on the competitiveness of WOBs, while the influence of contract management on competitiveness of WOBs was not statistically significant. We, therefore, concluded that public procurement can indeed enhance women empowerment through a gender-responsive procurement policy. Above all, pre-contract award interventions such as streamlining evaluation criteria to ease access of WOBs to public procurement contracts seem have the most significant impact to competitiveness of WOBs compared to post-ward interventions during contract management.Originality/valueThis study offers a research-based model that articulates the role of procurement policy as an enabler for competitiveness of WOBs in developing countries. The model proposes a combination of both policy (a direct influence) and interventions in the supplier selection process (an indirect influence) to boost the competitiveness of WOBs.

Abstract Background To reduce the under-five mortality (U5M), fine-gained spatial assessment of the effects of health interventions is critical because national averages can obscure important sub-national disparities. In turn, sub-national estimates can guide control programmes for spatial targeting. The purpose of our study is to quantify associations of interventions with U5M rate at national and sub-national scales in Uganda and to identify interventions associated with the largest reductions in U5M rate at the sub-national scale. Methods Spatially explicit data on U5M, interventions and sociodemographic indicators were obtained from the 2011 Uganda Demographic and Health Survey (DHS). Climatic data were extracted from remote sensing sources. Bayesian geostatistical Weibull proportional hazards models with spatially varying effects at sub-national scales were utilized to quantify associations between all-cause U5M and interventions at national and regional levels. Bayesian variable selection was employed to select the most important determinants of U5M. Results At the national level, interventions associated with the highest reduction in U5M were artemisinin-based combination therapy (hazard rate ratio (HRR) = 0.60; 95% Bayesian credible interval (BCI): 0.11, 0.79), initiation of breastfeeding within 1 h of birth (HR = 0.70; 95% BCI: 0.51, 0.86), intermittent preventive treatment (IPTp) (HRR = 0.74; 95% BCI: 0.67, 0.97) and access to insecticide-treated nets (ITN) (HRR = 0.75; 95% BCI: 0.63, 0.84). In Central 2, Mid-Western and South-West, largest reduction in U5M was associated with access to ITNs. In Mid-North and West-Nile, improved source of drinking water explained most of the U5M reduction. In North-East, improved sanitation facilities were associated with the highest decline in U5M. In Kampala and Mid-Eastern, IPTp had the largest associated with U5M. In Central1 and East-Central, oral rehydration solution and postnatal care were associated with highest decreases in U5M respectively. Conclusion Sub-national estimates of the associations between U5M and interventions can guide control programmes for spatial targeting and accelerate progress towards mortality-related Sustainable Development Goals.

Background: Update and utilization of modern contraceptives has public health benefits including reduction of unintended pregnancies, unsafe abortions, and related maternal mortality. However, paucity of evidence on key indicators of family planning in the informal settlements abounds. Data are usually collapsed within the larger urban communities that tend to mask peculiarities of informal settlements. This study determined the proportion of women using modern contraceptives, the unmet need for modern contraceptives and the total demand in informal settlements of an urban municipality.Methods: A cross-sectional study conducted among 626 women in the reproductive age (15–49 years) in the informal settlements of Kira municipality (part of metropolitan Kampala). Multi-stage sampling was applied in the selection of the respondents. Descriptive and log-binomial regression analysis were conducted to determine percentage of women using modern contraceptives, unmet need, and total demand with their associated factors. All analyses were conducted using STATA version 15.0.Results: The total demand for modern contraceptives was 84.9%, modern contraceptive prevalence was 47.4% nearly meeting the national target of 50%, however the unmet need was 37.3%, which much higher than the national target of 10%. Lower total demand for contraceptives was associated with higher women's education status and preference to have another child, while higher total demand was associated with having at least one living child. Higher modern contraceptives use was associated with older age, having at least one living child and high decision-making power, while lower modern contraceptives use was associated with higher education and undetermined fertility preference. Lower unmet need for modern contraceptives was associated with older age (PR 0.68, 95% CI: 0.48–0.97) and high decision-making power (PR 0.64, 95% CI: 0.50–0.81), while higher unmet need was found among those who having at least one living child (PR 1.40, 95% CI: 1.01–1.93) and undetermined fertility preference (PR 1.70, 95% CI: 1.24–2.34).Conclusions: Total demand and contraceptive use were found to be higher in the informal settlements of Kira municipality, however, the unmet need was much higher among this population as compared to the national urban estimates. This indicates a much higher demand for contraceptives and the need to consider the diverse socio-demographic characteristics of urban spaces. Development of Interventions need to critically consider the diverse urban space, associated explanatory variables and a collaborative systems lens to achieve sustained improvements.