Journal articles on the topic 'Sex role – Uganda'

Purpose The purpose of this paper is to establish socio-economic factors and maternal practices that determine child mortality in Uganda. Design/methodology/approach The paper examines the role of sex, birth weight, birth order and duration of breastfeeding of a child; age, marital status and education of the mother; and household wealth in determining child mortality. The study employs a logistic regression model to establish which of the factors significantly impacts child mortality in Uganda. Findings The study established that education level, age and marital status of the mother as well as household wealth significantly impact child mortality. Also important are the sex, birth weight, birth order and breastfeeding duration. Research limitations/implications Policies aimed at promoting breastfeeding and education of female children can make a significant contribution to the reduction of child mortality in Uganda. Practical implications Health care intervention programs should focus on single, poor and uneducated mothers as their children are at great risk due to poor and inadequate health care utilization. Originality/value This paper could be the first effort in examining child mortality status in Uganda using a logistic regression model.

ObjectivesTo compare the prevalence of detectable coronary artery calcium (CAC) among higher risk, older people living with HIV (PLWH) and uninfected persons in Uganda versus the USA, and second to explore associations of CAC with HIV-specific variables and biomarkers of inflammation.MethodsThis cross-sectional study of 430 total subjects compared 100 PLWH on antiretroviral therapy and 100 age-matched and sex-matched HIV-uninfected controls in Uganda with 167 PLWH on antiretroviral therapy and 63 uninfected controls in the USA. Multivariable logistic regression was used to examine associations with detectable CAC (CAC >0).ResultsCompared with US subjects, Ugandans were older (mean age 56 vs 52 years) and were more likely to have diabetes (36% vs 3%) and hypertension (85% vs 36%), but were less likely to be male (38% vs 74%) or smokers (4% vs 56%). After adjustment for HIV serostatus, age, sex and traditional risk factors, Ugandans had substantially lower odds of CAC >0 (adjusted OR 0.07 (95% CI 0.03 to 0.17), p<0.001). HIV was not associated with CAC >0 in either country (p>0.1). Among all PLWH, nadir CD4 count was associated with the presence of CAC, and among Ugandans soluble intercellular adhesion molecule (p=0.044), soluble CD163 (p=0.004) and oxidised low-density lipoprotein (p=0.043) were all associated with the presence of CAC.ConclusionsUgandans had a dramatically lower prevalence of any coronary calcification compared with US subjects. The role of HIV infection and inflammation as risk factors for subclinical coronary disease in sub-Saharan Africa merits further investigation.

The principles of equality and non-discrimination represent the twin pillars or the cornerstone upon which the whole edifice of human rights law is established.1 At least every State in the world today is a party to a human rights treaty prohibiting discrimination on the basis of sex and/or protecting equality between men and women.2 Despite this fact inequality and discrimination remain two major impediments to the enjoyment of human rights of women. Discrimination against women on the basis of sex denies or limits as it does their equality with men, and is ‘fundamentally unjust’ since it violates the principles of equality of rights and respect for human dignity.3 It is an obstacle to the participation of women, on equal terms with men, in the political, social, economic and cultural life of their States, hampers the growth of the prosperity of society and the family and makes more difficult the full development of the potentialities of women.4 International human rights instruments such as Article 3 of the International Covenant on Civil and Political Rights (ICCPR)5 and Article 3 of the International Covenant on Economic, Social and Cultural Rights (ICESCR)6 underline commitment to sexual equality in the enjoyment of all civil and political rights, as well as economic, social and cultural rights. Similarly, Article 2 and 3 of the African Charter on Human and Peoples’ Rights (ACHPR) prohibit discrimination and protect equality before the law.7 This demands de jure (or formal) equality and de facto (or substantive) equality for men and women.8 Formal equality assumes that equality is achieved if a law or policy treats men and women in a neutral manner.9 Substantive equality is concerned, in addition, with the effects of laws, policies and practices and with ensuring that they do not maintain, but rather alleviate, the inherent disadvantages that particular groups experience.10

Masculinity and femininity debates of armed conflict in Africa have always regarded men as fighters and women as passive victims of war. The exclusion of women from the armed forces in most traditional societies originated from the assumption that women are a weaker sex and therefore cannot manage military life. Nevertheless, women in Uganda have voluntarily joined the armed forces, while some of them have been abducted and forcefully recruited into the rebel forces. Notwithstanding the central role women have played in the armed conflict in Northern Uganda, they have been side-lined in the processes of peace negotiation and post conflict reconstruction ofthe region. This paper looks at how masculinity is manipulated in conflict and the role women have played in the conflict, peace process and post conflict reconstruction in Northern Uganda.Keywords · Gender · Post-conflict reconstruction · Transitional justice

Background and Purpose— Rates of intracerebral hemorrhage (ICH) are estimated to be highest globally in sub-Saharan Africa. However, outcomes of ICH are poorly described and standard prognostic markers for ICH have not been validated in the region. Methods— We enrolled consecutive patients with computed tomography-confirmed ICH at a referral hospital in southwestern Uganda. We recorded demographic, clinical, and radiographic features of ICH, and calculated ICH scores. We fit Poisson regression models with robust variance estimation to determine predictors of case fatality at 30 days. Results— We enrolled 73 individuals presenting with computed tomography-confirmed ICH (mean age 60 years, 45% [33/73] female, and 14% [10/73] HIV-positive). The median ICH score was 2 (interquartile range, 1–3; range, 0–5). Case fatality at 30 days was 44% (32/73; 95% CI, 33%–57%). The 30-day case fatality increased with increasing ICH score of 0, 1, and 5 from 17%, 23%, to 100%, respectively. In multivariable-adjusted models, ICH score was associated with case fatality (adjusted relative risk, 1.48; 95% CI, 1.23–1.78), as were HIV infection (adjusted relative risk, 1.92; 95% CI, 1.07–3.43) and female sex (adjusted relative risk, 2.17; 95% CI, 1.32–3.59). The ICH score moderately improved with the addition of a point each for female sex and HIV serostatus (0.81 versus 0.73). Conclusions— ICH score at admission is a strong prognostic indicator of 30-day case fatality in Uganda. Our results support its role in guiding the care of patients presenting with ICH in the region.

Background. The aim of the study was to evaluate current knowledge, risk behavior, and attitudes among pregnant women in Mateete, Uganda. Methods. We collected 100 questionnaires and performed 20 interviews among women who attended antenatal care. Findings. All the women had heard about HIV/AIDS, and 92% were aware of mother-to-child transmission. The women overestimated the risk of achieving the virus since 45% believed in transmission by mosquitoes and 44% by kissing. Many pointed out that married women as a group were infected more often because of unfaithful partners who refused to use condoms during sex. Conclusion. The women were well aware of the routes of HIV transmission. Schools and governmental campaigns have played an important role in educating people about the disease but there is still a great need to reach out to people in rural areas with both health care and correct information.

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.

AbstractPatterns of allogrooming among the Sonso community of chimpanzees of the Budongo Forest, Uganda, were examined and found to closely resemble those at other study sites. Strong affiliative bonds among males were reflected in high levels of grooming compared with other sex combinations. Adult males groomed, and received grooming most often from, other adult males and also adolescent females which were the only females with regular oestrous cycles during the study. Males had a wider diversity of grooming partners than females and groomed more equitably. However, males concentrated the majority of their effort on a very small number of partners compared with other sites. Grooming reciprocity was found among all age/sex combinations with the exception of adult male-female dyads once immediate reciprocation in the form of synchronous mutual grooming was removed from the analysis. Since grooming among males is thought to play a major role in servicing relationships and agonistic coalitions that can improve dominance status, competition for high-ranking grooming partners was predicted to influence the distribution of grooming among males. Grooming was indeed directed up the male hierarchy and closely ranked males groomed each other more often than those that were distantly ranked. However, when only adult males were considered, rank had little effect on grooming distributions. High rank appeared to influence access to females, but did not attract more female grooming partners. Grooming distributions in this average-sized community did not fit a number of alternative priority of access models which assume competition for high-ranking grooming partners that Watts (2000b) found to have some explanatory value in one very large community of chimpanzees, but not in a smaller, more representative one. Although rank is highly likely to influence coalition partner choice, whether such relationships depend upon strategic grooming partner choices in wild chimpanzees is presently unclear.

Abstract Abstract 4262 Anemia in children under 5 years of age, defined by the World Health Organization as a hemoglobin (hb) level < 11g/L, is a global public health problem, affecting a significant percentage of the world's children. In addition to its contribution to childhood mortality, the role of anemia in cognitive impairment and educational attainment is also well recognized. According to the 2000-01 Demographic Health Survey (DHS), the prevalence of anemia in Uganda was 64% among children <5, similar to other countries in the region. A subsequent 2006 DHS noted that the prevalence of anemia had increased to 72% in Uganda. Although it is estimated that nearly half of all cases of anemia are due to iron deficiency, the causes of anemia, which disproportionately affect children and pregnant woman, are multifactorial and include nutritional deficiencies and parasitic infections. In endemic regions, the causative role of malaria is particularly important. The 2009 Uganda Malaria Indicator Survey (UMIS) is a nationally representative household survey which collects demographic data and measurements of hemoglobin and testing for malaria in addition to coverage estimates of malaria prevention and control activities. Hemoglobin measurements were collected via the HemoCue®, a point of use test. Malaria was detected both by peripheral blood smear and via the rapid diagnostic test, Paracheck-Pf®, which detects the presence of histidine rich protein 2 (HRP2). For this analysis, we utilized the results of the rapid diagnostic test, which is characterized by high sensitivity but lower specificity as the tests detect HRP2 which persists in the bloodstream after clearance of the parasite. The UMIS collected data on household assets. Using principal component analysis, a wealth index was created and households were stratified into wealth quintiles. We analyzed data on hemoglobin levels (adjusted for altitude) among children under 5 years. We assessed various risk factors and performed both univariate and bivariate analyses. Those variable which were significantly associated with anemia (p <0.05) were included in the multivariate analysis. The UMIS utilized a two-stage sample design; 4,421 households were randomly selected (response rate 97.5%) from 170 clusters. Half (51%) of the sampled children were female and over 80% were between 12 and 59 months. Of the 4,065 children under 5 in the sample, hemoglobin measurements were obtained on 3,878 children (95%). Of these, 61% of children <5 had a hb level less than 11 g/L; nearly 10% were severely anemic with a hb less than 8 g/L. On bivariate analysis, anemia was more common in children between 12–59 months (p =.001), living in rural areas (p=.001), in households in the poorest wealth quintiles (p<.001), in those households having problems in satisfying their food needs (p<.001) and among those with concomitant malaria infection (p <.001). The prevalence of anemia among children who tested negative for malaria was 45% (versus 77% among those who tested positive). Maternal education was inversely associated with anemia (p=.009). Neither household size nor distance to the nearest health facility were associated with anemia. The sex of the child was also not associated with anemia. Using a logistic regression model, only simultaneous malaria infection (p <.001) and living in poorer households (p <.001) were associated with anemia. While the prevalence of anemia has decreased in Uganda since the most recent national household survey in 2006, the burden of anemia remains unacceptably high. In this analysis, the detection of malaria via Paracheck-Pf® was significantly associated with anemia. Clearly, malaria prevention and effective treatment measures have expanded and as such have reduced the prevalence of malaria during this interim. While these control efforts are likely responsible for the observed downward trend in anemia prevalence, such public health endeavors are unlikely to be sufficient to reduce the burden of anemia. Although the UMIS did not collect data on nutritional deficiencies, previous studies have documented the high percentage of anemia attributed to iron deficiency globally. Therefore, prevention of anemia via iron supplementation and antihelmintics, in conjunction with malaria prevention and treatment strategies, will likely be necessary to halt the global toll of anemia. Disclosures: No relevant conflicts of interest to declare.

Background: Endemic Burkitt lymphoma (eBL) is the most common childhood cancer in Africa and is linked to Plasmodium falciparum (Pf) malaria infection, one of the most common and deadly childhood infections in Africa; however, the role of Pf genetic diversity is unclear. A potential role of Pf genetic diversity in eBL has been suggested by a correlation of age-specific patterns of eBL with the complexity of Pf infection in Ghana, Uganda, and Tanzania, as well as a finding of significantly higher Pf genetic diversity, based on a sensitive molecular barcode assay, in eBL cases than matched controls in Malawi. We examined this hypothesis by measuring diversity in Pf-serine repeat antigen-5 (Pfsera5), an antigenic target of blood-stage immunity to malaria, among 200 eBL cases and 140 controls, all Pf polymerase chain reaction (PCR)-positive, in Malawi. Methods: We performed Pfsera5 PCR and sequencing (~3.3 kb over exons II–IV) to determine single or mixed PfSERA5 infection status. The patterns of Pfsera5 PCR positivity, mixed infection, sequence variants, and haplotypes among eBL cases, controls, and combined/pooled were analyzed using frequency tables. The association of mixed Pfsera5 infection with eBL was evaluated using logistic regression, controlling for age, sex, and previously measured Pf genetic diversity. Results: Pfsera5 PCR was positive in 108 eBL cases and 70 controls. Mixed PfSERA5 infection was detected in 41.7% of eBL cases versus 24.3% of controls; the odds ratio (OR) was 2.18, and the 95% confidence interval (CI) was 1.12–4.26, which remained significant in adjusted results (adjusted odds ratio [aOR] of 2.40, 95% CI of 1.11–5.17). A total of 29 nucleotide variations and 96 haplotypes were identified, but these were unrelated to eBL. Conclusions: Our results increase the evidence supporting the hypothesis that infection with mixed Pf infection is increased with eBL and suggest that measuring Pf genetic diversity may provide new insights into the role of Pf infection in eBL.

Abstract 30 Background and objective: Co-infection with Hepatitis B (HBV) and HIV is common in sub-Saharan Africa (SSA) and accelerates progression of liver disease to cirrhosis, hepatocellular carcinoma (HCC) and other complications. About 60% of HCC in Africa is attributed to HBV. In Uganda, 80% of HCC patients have HBV and 20% have HIV/HBV coinfection. HCC is the 4th commonest cancer among Ugandan males and the 6th commonest in females. It is almost always a fatal malignancy in SSA. Prevention of HBV is best achieved through vaccination. Vaccination of HIV-infected adults for HBV is standard of care in developed countries but not in SSA where HBV is believed to be acquired in childhood and where there is lack of HBV incidence data. We investigated the incidence and risk factors associated with HBV among HIV-infected adults in Rakai, Uganda. Methods: We screened stored sera from 944 HIV infected adults enrolled in the Rakai Community Cohort Study between September 2003 and March 2015 for evidence of HBV exposure using the anti-HBc marker. Serum from participants who tested anti-HBc negative (497) at the baseline round was tested over 3-7 consecutive survey rounds for either anti-HBc or HBsAg sero-conversion. The time of HBV incidence was defined as the median date between the last anti-Hbc or HBsAg negative sample and the first positive anti-HBc or HBsAg serum sample. Almost all ART treatment regimens contained at least one HBV active medication. Exact poisson incidence methods were used to estimate the incidence of HBV with 95% confidence intervals while the Cox proportional regression methods were used to estimate adjusted hazard ratios of ART use and other confounders. Results: Thirty nine infections occurred (8 positive for both HBsAg and anti-HBc, 3 for HBsAg only, and 28 for anti-HBc only) over 3,342 person-years (pys), incidence 1.17/100 person-years. HBV incidence was significantly lower with ART use: 0.48 /100 person-years with ART use and 2.34/100 person-years without ART (p<0.001) and with HIVRNA suppression: 0.6/100pys with HIVRNA ≤400 copies/mL 6.0/100pys with >400copies/mL (p<0.001). It also decreased significantly with age: 2.60/100 pys if aged 15-29 years, 1.32/100 pys if aged 30-39 years and 0.48/100 pys if aged 40-50 years (p<0.001). The adjusted hazard ratios of HBV incidence significantly differed by ART use: non ART use versus ART use, aHR=0.24 (95% CI, 0.1-0.5), lamivudine (3TC) use: no ART versus 3TC-based ART, aHR= 0.24(0.1-0.5), p=<0.001), HIVRNA suppression ≤400 versus >400copies/mL, aHR= 6.4(2.2-19.0) and by age: 40-50 years versus 15-29 years, aHR= 3.66 (1.3-10.2); 40-50 years versus 30-39 years, aHR=2.18(0.9-5.4). No new HBV infections occurred among participants on a tenofovir-based regimen and there was no statistical significant differences by gender, occupation, marital status or number of sex partners, duration on ART or baseline CD4 count. Conclusion: The protective effects of HBV-active ART medications underscores additional benefits of earlier initiation of ART. Ongoing HBV transmission demonstrated by this study represents an opportunity for vaccine preventive strategies which could ultimately significantly reduce the burden of HCC in SSA. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: Emmanuel Seremba No relationship to disclose Victor Ssempijja No relationship to disclose Sarah Kalibbala No relationship to disclose Ronald Gray No relationship to disclose Maria Wawer No relationship to disclose Fred Nalugoda No relationship to disclose Corey Casper Consulting or Advisory Role: Temptime Corporation, GlaxoSmithKline Research Funding: Janssen Pharmaceuticals Travel, Accommodations, Expenses: GlaxoSmithKline, TempTime Warren T. Phipps No relationship to disclose Ponsiano Ocama No relationship to disclose David L. Thomas No relationship to disclose Steven J. Reynolds No relationship to disclose

e22235 Background: AP unlike HTLV-I associated diseases arrived late in parts of Africa, including Nigeria, where retroviral research was already ongoing in collaboration with the US National Cancer Institute (USNCI), thus providing unique preventive interventional opportunity. A World Health Organization sponsored study of the role of sexual behavior in retroviral transmission in Nigeria was performed 1985–86. Methods: Using an ELISA and an investigational Western blot (IWB) assay, a small survey of the seroprevalence rate (SPR%) of HTLV-I and HIV was conducted in 3 regions of the country among 5 population groups with differing sexual behaviors: normal blood donors (NBD), female commercial sex workers (FCSW), sexually transmitted diseases patients, and religious male/female celibates. 204 samples were re-tested with recombinant enhanced “Singapore” HIV-1/2 WB (SWB) in 1994, in view of earlier HIV-1 IWB negativity. All serological tests were done at USNCI. Results: HTLV-I SPR varied by region and lifestyle, highest in eastern region (ER) (p=0.0000095), FCSW of ER (p=0.0006), and frequency of male heterosexual activity (p=0.024). HIV-1 was undetectable by IWB, while SWB revealed 2/204 HIV-1+ for countrywide SPR: ∼1.0; Western NBD: 1/100 (1.0); Western/Northern NBD: 1/184 (0.54): non-high risk Nigerians: 2/237 (0.84); FCSW: 0/46; celibates: 0/71, adult general Nigerian population (AGNP): ∼0.5–1.0, and translating to (∼240–480)x103 HIV-1+ AGNP. Assuming 20 HIV-1+ = 1 case of AIDS death, SWB- determined SPR predicted (∼12–24)×103 AIDS deaths among 48×106 AGNP in 1985–86, ∼5 of (2.4- 4.8)×103 (<0.2%) of whom presented with clinical AIDS features (CAF) at Nigeria's premier health institution (NPHI). Conclusions: In 1985–86, when patients with CAF rarely presented at NPHI and HIV-1 SPR was ≤1.0 in AGNP and FCSW, Nigerian health authority was advised on AP risk, unlike Uganda where it arrived unanticipated. Reports of SPR of 7.7 and 60.0 in AGNP and FCSW in 1996–2000 contrast against contemporary Ugandan SPR (14.0 down to 6.1) and Senegalese (0.4 up to 0.9), probably resulting from varying knowledge gap and angst-related inertia, illustrating mixed fortunes of AP in Africa, transcontinental variation in AP control capability, and providing lessons for the management of future public health challenges. No significant financial relationships to disclose.

OBJECT The role of reopening an obstructed endoscopic third ventriculostomy (ETV) as treatment for ETV failure is not well defined. The authors studied 215 children with ETV closure who underwent successful repeat ETV to determine the indications, long-term success, and factors affecting outcome. METHODS The authors retrospectively reviewed the CURE Children's Hospital of Uganda database from August 2001 through December 2012, identifying 215 children with failed ETV (with or without prior choroid plexus cauterization [CPC]) who underwent reopening of an obstructed ETV stoma. Treatment survival according to sex, age at first and second operation, time to failure of first operation, etiology of hydrocephalus, prior CPC, and mode of ETV obstruction (simple stoma closure, second membrane, or cisternal obstruction from arachnoid scarring) were assessed using the Kaplan-Meier survival method. Survival differences among groups were assessed using log-rank and Wilcoxon methods and a Cox proportional hazards model. RESULTS There were 125 boys and 90 girls with mean and median ages of 229 and 92 days, respectively, at the initial ETV. Mean and median ages at repeat ETV were 347 and 180 days, respectively. Postinfectious hydrocephalus (PIH) was the etiology in 126 patients, and nonpostinfectious hydrocephalus (NPIH) in 89. Overall estimated 7-year success for repeat ETV was 51%. Sex (p = 0.46, log-rank test; p = 0.54, Wilcoxon test), age (< vs > 6 months) at initial or repeat ETV (p = 0.08 initial, p = 0.13 repeat; log-rank test), and type of ETV obstruction (p = 0.61, log-rank test) did not affect outcome for repeat ETV (p values ≥ 0.05, Cox regression). Those with a longer time to failure of initial ETV (> 6 months 91%, 3–6 months 60%, < 3 months 42%, p < 0.01; log-rank test), postinfectious etiology (PIH 58% vs NPIH 42%, p = 0.02; log-rank and Wilcoxon tests) and prior CPC (p = 0.03, log-rank and Wilcoxon tests) had significantly better outcome. CONCLUSIONS Repeat ETV was successful in half of the patients overall, and was more successful in association with later failures, prior CPC, and PIH. Obstruction of the original ETV by secondary arachnoid scarring was not a negative prognostic factor, and should not discourage the surgeon from proceeding. Repeat ETV may be a more durable solution to failed ETV/CPC than shunt placement in this context, especially for failures at more than 3 months after the initial ETV. Some ETV closures may result from an inflammatory response that is less robust at the second operation.

Abstract Objectives To assess the association between play and interaction, and developmental outcomes in children with moderate acute malnutrition (MAM) in a prospective cohort of hospitalized children in Malawi and Uganda (http://www.chainnetwork.org). Methods Children (age 2– 23 months) requiring hospitalization for acute illness were enrolled from January 2017 till December 2018. Children meeting WHO criteria for MAM by mean upper arm circumference (MUAC) were included in this sub-analysis. Child development was assessed using the Malawi Developmental Assessment Tool at discharge and 180-day follow-up. The Family Care Indicator (FCI) evaluated the number of play items and interactions in the home. Developmental outcomes at discharge and follow-up were assessed using paired t-test. Linear regression analysis examined associations between FCI score and developmental outcomes at follow-up, with adjustment for sex, prematurity, height-for-age z-score and HIV status, parental education, household assets, and maternal mental health. Results 128 children with MAM (52.3% male, mean age 11.3 months (±4.5) were included (mean MUAC 120 mm ± 3.2). Children were excluded for: pre-existing neurodisability (n = 5), death during follow-up (n = 4), and loss to follow-up (n = 22). At discharge 24.4% of the children had delays in the gross motor domain, 18.7% in the fine motor domain, 4.1% in the language domain and 7.3% in the social domain. Over the 6-month study period, significant improvements (P &lt; 0.001) in the mean difference of gross motor (1.3), fine motor (0.83) and social domain (0.59) Z-scores were observed. No significant change was identified in the language domain Z-score. Adjusted linear regression revealed that a one-point increase in the number of play items was associated with an increase in gross motor z-score of 0.16 (95% CI 0.01–0.32, P = 0.04) and a one point increase in interaction activities was associated with an increase in language z-score of 0.27 (95% CI 0.03–0.51, P = 0.03) at follow-up. Conclusions Children with MAM admitted for an acute illness showed significant improvements in developmental outcomes at 180-day follow-up. The role of play and interaction activities at home should be further investigated for their potential to promote developmental outcomes in children with MAM. Funding Sources Bill and Melinda Gates Foundation.

In most Russian and international studies, including African ones, their authors portray African women that reside in areas affected by civil wars and conflicts as victims of violence, robbery, forced labor, etc. At the same time, it is rarely taken into account that in most national liberation movements and rebel groups the number of women fighters constituted and still constitutes 10-30% of their rank and file. Moreover, many women became field commanders, chiefs of intelligence, or were responsible for the supply of weapons and ammunition. The present authors provide a new interpretation of the participation and role of women in the confrontation between armed anti-government factions and the central government. It is noted that in recent decades, not only in Africa, but also in other parts of the world, the trend towards “feminization of the militarization process” has become extremely noticeable. Many women, along with men, participate in acts of violence, including against the civilian population, and thus contribute to the destabilization of the internal political situation. Women most actively participated in hostilities in the Democratic Republic of the Congo, Zimbabwe, Côte d’Ivoire, Liberia, Mozambique, Sierra Leone, Uganda, Eritrea and Ethiopia. The present paper looks into reasons and consequences of women’s involvement in insurgencies. It is pointed out that while during the years of the national liberation struggle women were motivated by the overarching goal of achieving independence, in later conflicts many of them fought to expand their political and economic rights and opportunities, i.e., to achieve gender equality. In addition to joining “armed groups” for ideological reasons, women tried to prove that they were “no worse than men”; others joined the ranks of the insurgents to protect themselves and other women from violence or death, i.e., they followed a kind of “survival strategy”. Particular attention is paid to suicide bombers, who have been increasingly used by the Islamist organization Boko Haram in recent years. The authors also consider the conditions in which demobilized women-combatants find themselves. The authors conclude that as the level of women’s involvement in African conflicts is constantly growing, it ceases to be an anomaly and to some extent reflects the “successes” achieved by the “fair sex” in the struggle for equality, although the negative consequences of this participation prevail over the positive ones.

PurposeThe purpose of this paper is to establish the mediating role of collective action in the relationship between financial intermediation and financial inclusion of the poor in rural Uganda.Design/methodology/approachThe paper uses structural equation modeling (SEM) through bootstrap approach constructed using analysis of moment structures to test for the mediating role of collective action in the relationship between financial intermediation and financial inclusion of the poor in rural Uganda. Besides, the paper adopts Baron and Kenny’s (1986) approach to establish whether conditions for mediation by collective action exist.FindingsThe results revealed that collective action significantly mediates the relationship between financial intermediation and financial inclusion of the poor in rural Uganda. The findings further indicated that the mediated model had better model fit indices than the non-mediated model under SEM bootstrap. Furthermore, the results showed that both collective action and financial intermediation have significant and direct impacts on financial inclusion of the poor in rural Uganda. Therefore, the findings suggest that the presence of collective action boost financial intermediation for improved financial inclusion of the poor in rural Uganda.Research limitations/implicationsThe study used quantitative data collected through cross-sectional research design. Further studies through the use of interviews could be adopted in future. Methodologically, the study adopted use of SEM bootstrap approach to establish the mediating effect of collective action. However, it ignored the Sobel’s test and MedGraph methods. Future studies could adopt the use of alternative methods of Sobel’s test and MedGraph. Additionally, the study focused only on semi-formal financial institutions. Hence, further studies may consider the use of data collected from formal and informal institutions.Practical implicationsPolicy makers and managers of financial institutions should consider the role of collective action in promoting economic development, especially in developing countries. They should create structures and design financial services and products that promote collective action among the poor in rural Uganda.Originality/valueAlthough several scholars have articulated financial inclusion based on both the supply and demand side factors, this is the first study to test the mediating role of collective action in the relationship between financial intermediation and financial inclusion of the poor in rural Uganda using SEM bootstrap approach. Theoretically, the study combines the role of collective action with financial intermediation to promote financial inclusion. Financial intermediation theory ignores the role played by collective action in the intermediation process between the surplus and deficit units.

The paper investigates the role of knowledge management in enabling project success, innovation, completion times, operational efficiency and the generation of new knowledge in development projects. Four projects in Uganda, Nigeria, and Cote d'Ivoire were used as case studies. The objective was to explore the nature of knowledge management practices in these projects in order to see how they could be improved. The research found that knowledge management is a significant factor in speeding up completion times, achieving project success, innovation, operational efficiency and the generation of new knowledge. Knowledge sharing practices were identified within case studies and difficulties relating to managing knowledge generated during the project were highlighted.

Purpose The purpose of this paper is to report the findings on the mediating effect of social network in the relationship between institutional framework and financial inclusion in rural Uganda. Design/methodology/approach The study employs a cross-sectional research design to collect data used to test for mediation under this study. Structural equation model (SEM) through use of bootstrap in the Analysis of Moment Structures (AMOS) was adopted to establish the existence and type of mediation by social network in the relationship between institutional framework and financial inclusion. Findings Social network had a partial mediating effect in the relationship between institutional framework and financial inclusion. In addition, institutional framework through its regulative, normative and cultural-cognitive pillars also exhibited a significant direct effect on financial inclusion. Besides, social network had a positive and significant effect on financial inclusion. This suggest that there exist both a direct effect of institutional framework on financial inclusion and an indirect effect of institutional framework through social network on financial inclusion. Research limitations/implications While the sample for this study was big enough, it limited itself to only poor households in rural Uganda. Besides, the current study adopted cross-sectional design, thus, leaving out longitudinal design to investigate the characteristics in the sample over time. Practical implications The study makes significant empirical contribution and implications to financial inclusion policy makers on evidence of the critical role played by social network in indirectly enhancing the relationship between institutional framework and financial inclusion of the poor who are vulnerable to exclusion by main stream financial services’ providers. Originality/value The study recommends that social network, which acts as a conduit through which useful information flow and can be shared, plays a critical role in mediating the relationship between institutional framework and financial inclusion in rural Uganda. Therefore, the study contributes to existing body of literature by highlighting the mediating influence of social network in the relationship between institutional framework and financial inclusion, especially in rural Uganda.

Organizational culture plays a pivotal role in the development and change of organizations. To achieve institutional competitiveness and repositioning on the world market all key players in the institutional development need to be on the same page in terms of organizational culture. A mammoth of studies have been done in the past to explore organizational culture structure but there were no attempts done to validate and measure the construct on employee behaviour and thoughts at the Islamic University in Uganda. The purpose of this study therefore is to measure and validate organisational construct as perceived by staff at the Islamic University in Uganda. The study employed four dimensions to examine organizational culture, and 361 staff through randomization participated in the study. To arrive at the intention of the study SEM-Amos technique of data analysis was used to confirm the hypothesized measurement model. The results indicated that meaningful value, support and promotion of values, discipline values and free style value are true and valid predictors of organizational culture structure.

Household air pollution (HAP) and chronic HIV infection are each associated with significant respiratory morbidity. Little is known about relationships between HAP and respiratory symptoms among people living with HIV. The objective of this study was to investigate the relationship between cooking fuel type and chronic respiratory symptoms in study participants from the Uganda AIDS Rural Treatment Outcomes Study.Study participants were enrolled at the time of antiretroviral therapy initiation and seen quarterly from 2005 to 2014 for health-focused questionnaires, CD4 count and HIV viral load. We used multivariable logistic regression and generalised estimating equations, with each study visit as a unit of observation, to investigate relationships between cooking fuel type and chronic respiratory symptoms.We observed an association between cooking with firewood (versus charcoal) and chronic cough among HIV-infected females in rural Uganda (adjusted OR 1.41, 95% CI 1.00–1.99; p=0.047). We did not observe an association between cooking fuel type and respiratory symptoms among males (adjusted OR 0.88, 95% CI 0.47–1.63; p=0.658).Associations between cooking fuel and chronic cough in this HIV-infected cohort may be influenced by sex-based roles in meal preparation. This study raises important questions about relationships between household air pollution, HIV infection and respiratory morbidity.

Begomoviruses are plant viruses that cause major losses to many economically important crops. Although they are poorly understood, begomoviruses infecting wild plants may have an important role as reservoirs in the epidemiology of viral diseases. This study reports the discovery and genomic characterization of three novel bipartite begomoviruses from wild and cultivated African basil (Ocimum gratissimum) plants collected in Uganda, East Africa. Based on the symptoms shown by the infected plants, the names proposed for these viruses are Ocimum yellow vein virus (OcYVV), Ocimum mosaic virus (OcMV), and Ocimum golden mosaic virus (OcGMV). Genome and phylogenetic analyses suggest that DNA-A of OcGMV is mostly related to begomoviruses infecting tomato in Africa, whereas those of OcYVV and OcMV are closely related to one another and highly divergent within the Old World begomoviruses. The DNA-A of all characterized begomovirus isolates are of a recombinant nature, revealing the role of recombination in the evolution of these begomoviruses. The viruses characterized here are the first identified in O. gratissimum and the first in Ocimum spp. in the African continent and could have important epidemiological consequences for cultivated basils and other important crops. [Formula: see text] Copyright © 2020 The Author(s). This is an open access article distributed under the CC BY 4.0 International license .

This paper reflects on the adequacy of strategic environmental assessment (SEA) reports based on a comparative analysis of SEA reports from five country contexts randomly selected. It briefly examines the role of SEA in basin or catchment planning and management. An overview on institutional and organizational context of SEA in Uganda is discussed. Although, SEA has been described as being a tool to improve strategic decision-making by integrating environmental issues into plans, policies and programmes, there is a growing concern on the adequacy of the SEA reports being prepared and how these reports come about. To be able to determine the adequacy of these SEA reports, the analysis focused on the stages of SEA that guide the SEA process. The results of the study show some examples of effective SEA practice, but still some of the case studies never dug deep but rather scratched the surface in terms of SEA process effectiveness. Based on key findings of the study, some recommendations for improving SEA practice for catchment planning are provided. SEA reports should be presenting key issues, providing clear proposals and conclusive results to facilitate the integration of SEA findings in decision-making. As that’s what SEA is about.

Mikrofinanz hat sich zu einem entwicklungspolitischen Schlagwort ausgebildet. In der Entwicklungszusammenarbeit gilt die Vergabe von Kleinstkrediten seit langem als Erfolgsmodell. Was steckt hinter diesem durch den Friedensnobelpreisträger Muhammad Yunus bekannt gewordenen Instrument? Wie sieht die Praxis in den Entwicklungsländern aus? Gibt es für Mikrofinanzierungen auch einen Markt in den entwickelten Ländern. Microfinance has raised high expectations regarding poverty alleviation in the developing countries. Lack of empirical evidence has not, however, diminished the enthusiasm of the proponents of microfinance. The perception that microfinance plays an important role in poverty alleviation has attracted substantial assistance from international donors and local governments. What are the instruments and tools for implementing microfinance successfully in a country? What are the challenges? We have chosen Uganda in East Africa as a good example to see the lessons learnt in microfinance. Even in the industrialized world microfinance plays a more and more important role in the financial sector for customers and institutional investors. Keywords: mikrofinanzierungen, microfinances

Abstract This article examines the development of American policy in the Democratic Republic of the Congo. Why did the U.S. become involved? I argue that Washington’s policy was based in how they framed the conflict. They chose to see it through the prism of Rwandan and Ugandan security needs. The Administration favored the narrative of genocide instead of contemplating a war of “partition and plunder.” This may not be surprising because Washington often privileges a Westphalian approach to security and ignores the role of economic sub-state actors. However, by doing so they exhibited a “crushing neutrality” towards Laurent Kabila.

Bacterial wilt (BW) caused by the Ralstonia solanacearum species complex (RSSC) is a serious threat to potato production in Uganda. However, little is known about the extent of the disease and the type of the pathogen strains involved. A nationwide survey was conducted to study BW prevalence and incidence in potato, and potato tuber and stem samples of potential alternative hosts were collected for pathogen isolation. DNA was extracted from pure cultures for genetic diversity studies. The pathogen was phylotyped by multiplex PCR; then, a subset of isolates was typed at sequevar level. Isolates of the same sequevar were then haplotyped using multilocus tandem repeat sequence typing (TRST) schemes. BW prevalence and incidence in potato farms were 81.4 and 1.7%, respectively. Three RSSC phylotypes were identified, with the majority of the strains belonging to Phylotype II (80%) followed by Phylotype I (18.5%) and III (1.5%). Phylotype I strains belonged to Sequevar 31, and Phylotype II strains belonged to Sequevar 1. Potato-associated Phylotype II Sequevar 1 strains were more diverse (27 TRST haplotypes) than nonpotato Phylotype I (5 TRST haplotypes). Mapping of TRST haplotypes revealed that three TRST haplotypes of Phylotype II Sequevar 1 strains play an important epidemiological role in BW of potato in Uganda being disseminated via latently infected seed. [Formula: see text] Copyright © 2019 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .

Purpose Drawing from the argument that mobile money services have a significant potential to provide a wide range of affordable, convenient and secure financial services, there have been rampant frauds on consumers of financial products over the digital financial platform. Thus, this study aims to establish the mediating effect of digital consumer protection in the relationship between mobile money adoption and usage and financial inclusion with data collected from micro small and medium enterprises (MSMEs) in northern Uganda. Design/methodology/approach To achieve the main objective of this study, a research model was developed to test for the mediating effect of digital consumer protection in the relationship between mobile money adoption and usage and financial inclusion. The data were collected from MSMEs and structural equation modelling in partial least square (PLS) combined with bootstrap was applied to analyze and test the hypotheses of this study. The direct and indirect effect of mobile money adoption and usage on financial inclusion was tested through digital consumer protection as a mediator variable. Findings The findings from the PLS-structural equation modelling (SEM) showed that mobile money adoption and usage has both direct and indirect effect on financial inclusion. Moreover, financial inclusion is influenced by both mobile money adoption and usage and digital consumer protection. Research limitations/implications The study used partial least square (PLS-SEM) combined with bootstrap confidence intervals through a formative approach to establish the mediating effect of the mediator variable. Hence, it ignored the use of covariance-based SEM and the MedGraph programme. Furthermore, data were collected from samples located in Gulu district, northern Uganda and specifically from MSMEs. This limits generalization of the study findings to other population who also use mobile money services. Practical implications Promoters of digital financial services, managers of telecommunication companies, and financial inclusion advocates should consider strengthening the existing digital consumer protection laws on the mobile money platform. A collaborative approach between the mobile network operators, financial institutions and regulators should tighten the existing laws against mobile money fraudsters and an efficient mechanism for recourse, compensation and remedy should be set up to benefit the victims of frauds and cybercrime on the Fintech ecosystem. Originality/value The current study gives a useful insight into the critical mediating role of digital consumer protection as a cushion for promoting financial inclusion through mobile phones over the Fintech that face great threat and risk from cyber insecurity.

Background Though institutional delivery plays a significant role in maternal and child health, there is substantial evidence that the majority of rural women have lower health facility delivery than urban women. So, identifying the drivers of these disparities will help policy-makers and programmers with the reduction of maternal and child death. Methods The study used the data on a nationwide representative sample from the most recent rounds of the Demographic and Health Survey (DHS) of four East African countries. A Blinder-Oaxaca decomposition analysis and its extensions was conducted to see the urban-rural differences in institutional delivery into two components: one that is explained by residence difference in the level of the determinants (covariate effects), and the other components was explained by differences in the effect of the covariates on the outcome (coefficient effects). Results The findings showed that institutional delivery rates were 21.00% in Ethiopia, 62.61% in Kenya, 65.29% in Tanzania and 74.64% in Uganda. The urban-rural difference in institutional delivery was higher in the case of Ethiopia (61%), Kenya (32%) and Tanzania (30.3%), while the gap was relatively lower in the case of Uganda (19.2%). Findings of the Blinder-Oaxaca decomposition and its extension showed that the covariate effect was dominant in all study countries. The results were robust to the different decomposition weighting schemes. The frequency of antenatal care, wealth and parity inequality between urban and rural households explains most of the institutional delivery gap. Conclusions The urban-rural institutional delivery disparities were high in study countries. By identifying the underlying factors behind the urban-rural institutional birth disparities, the findings of this study help in designing effective intervention measures targeted at reducing residential inequalities and improving population health outcomes. Future interventions to encourage institutional deliveries to rural women of these countries should therefore emphasize increasing rural women’s income, access to health care facilities to increase the frequency of antenatal care utilization.

Purpose Premised on the assertion that financial digitalization is currently the panacea and game changer in delivering progress towards the sustainable development goals (SDGs) through universal financial inclusion, especially in developing countries, the purpose of this paper is to establish the moderating effect of transaction tax exemptions in the relationship between mobile money adoption and usage and financial inclusion. Design/methodology/approach A semi-structured questionnaire was used to collect data from 379 micro, small and medium enterprises (MSMEs), which use mobile money services drawn from the Northern District of Gulu in Uganda to provide responses for this study. The predictive relevancy and the effect size of the model were determined by running partial least square algorithm through structural equation model (SEM) with 5,000 bootstrap samples in SmartPLS-SEM 3.0. Findings The findings indicated that all the latent variables of transaction tax exemptions showed significant and positive impact on mobile money adoption and usage to advance financial inclusion in developing countries. Moreover, when combined together, the overall SEM predictive model revealed a significant moderating effect of transaction tax exemptions in the relationship between mobile money adoption and usage and financial inclusion. This implies that transaction tax exemptions on digital financial innovations such as the mobile money services can stimulate economic growth through increased level of financial inclusion labeled as the main enabler in achieving the SDGs by the year 2030. Research limitations/implications Whereas data were collected from users of mobile money services, the samples were drawn specifically from MSMEs’ owners located in the Northern District of Gulu in Uganda. Thus, users located in other districts were not included in the sample for this study. Similarly, this study limited itself to only financial services offered through the mobile money platform. It ignored other digital financial channels such as the internet and electronic banking. Practical implications Going forward, in order to improve the economic well-being of households at the “bottom of the pyramid,” governments in developing countries should embrace the significant role of transaction tax exemptions in promoting digital financial innovations such as the mobile money services for increased level of financial inclusion. The governments in developing countries where mobile money has greatly spurred financial inclusion should not only reduce the existing transaction taxes on mobile money services but scrap it off in order to champion progressive increase in the level of universal financial inclusion prescribed as a key enabler in eliminating global poverty, especially in developing countries. Originality/value This study hints on the moderating effect of transaction tax exemptions in the relationship between mobile money adoption and usage and financial inclusion. The paradox in the current trends on transaction taxes on mobile money services, especially in developing countries remain a dearth in the nascent global FINTECH ecosystem.

PurposeTo coordinate humanitarian organisations with different mandates that flock the scenes of disasters to save lives and respond to varied needs arising from the increased number of victims is not easy. Therefore, the level at which organisations self-organise, network and adapt to the dynamic operational environment may be related to inter-organisational coordination. The authors studied self-organisation, organisational networks and adaptability as important and often overlooked organisational factors hypothesised to be related to inter-organisational coordination in the context of humanitarian organisations.Design/methodology/approachThe study’s sample consisted of 101 humanitarian organisations with 315 respondents. To decrease the problem of common method variance, the authors split the samples within each humanitarian organisation into two subsamples: one subsample was used for the measurement of self-organisation, organisational network and adaptability, while the other was for the measurement of inter-organisational coordination.FindingsThe partial least square structural equation modelling (PLS-SEM) analysis using SmartPLS 3.2.8 indicated that self-organisation is related to inter-organisational coordination. Organisational network and adaptability were found to be mediators for the relationship between self-organisation and inter-organisational coordination and all combined accounted for 57.8% variance in inter-organisational coordination.Research limitations/implicationsThe study was cross sectional, hence imposing a limitation on changes in perceptions over time. Perhaps, a longitudinal study in future is desirable. Data were collected only from humanitarian organisations that had delivered relief to refugees in the stated camps by 2018. Above all, this study considered self-organisation, adaptability and organisational networks in the explanation of inter-organisational coordination, although there are other factors that could still be explored.Practical implicationsA potential implication is that humanitarian organisations which need to coordinate with others in emergency situations may need to examine their ability to self-organise, network and adapt.Social implicationsSocial transformation is a function of active social entities that cannot work in isolation. Hence, for each to be able to make a contribution to meaningful social change, there is need to develop organisational networks with sister organisations so as to secure rare resources that facilitate change efforts coupled with the ability to reorganise themselves and adapt to changing environmental circumstances.Originality/valueThe paper examines (1) the extent to which self-organisation, adaptability and organisational networks influence inter-organisational coordination; (2) the mediating role of both adaptability and organisational networks between self-organisation and inter-organisational coordination in the context of humanitarian organisations against the backdrop of complex adaptive system (CAS) theory.

Background:Comorbidities have merged as an important field in Spondyloarthritis, however there is few data about its relationship to genetic factors such as HLA-B27.Objectives:To analyze the potential association between the presence of HLA-B27 and the different comorbidities observed in axSpA patients.Methods:A comparative cross-sectional study including axSpA patients from COMOSPA registry. COMOSPA is a worldwide registry that includes a wide set of anthropometric and clinical variables from 3984 patients with spondyloarthritis. The registry also includes the most frequent comorbidities observed in spondyloarthitis such as obesity, hypertension, diabetes, hyperlipidemia, heart ischemic disease, stroke, renal failure, neoplasms, peptic ulcer, diverticulitis, chronic obstructive pulmonary disease, and the presence of osteoporosis. A descriptive analysis and a multiple logistic regression model was performed including all variables assessed.Results:2370 patients fulfilled ASAS criteria of axSpA patients and were included in the study. 1858 (78.4%) of them were HLA-B27 positive. HLA-B27 positive axSpA patients presented significantly higher percentage of male sex, longer disease duration, higher percentage of definite Ankylosing Spondylitis, higher CRP levels, and were also more frequent tobacco consumers and excessive alcohol intakers compared to the negatives. However, disease activity measured by BASDAI, BASFI and ASDAS-CRP were all significantly higher in the HLA-B27 negative patients compared to the positive ones.The only association observed between any comorbidity and presence of gen HLA-B27 was the presence of osteoporosis. This association was independently significant even after adjusting in the multivariate analysis for all variables assessed.Conclusion:The association observed between the gen HLA-B27 and the presence of osteoporosis in axSpA patients could be of great relevance given the impact of osteoporosis in the phenotypical frame of axSpA patients.Disclosure of Interests:Marta Arévalo: None declared, Clementina López-Medina: None declared, Mireia Moreno: None declared, Anna Moltó Grant/research support from: Pfizer, UCB, Consultant of: Abbvie, BMS, MSD, Novartis, Pfizer, UCB, Font Ugalde Pilar: None declared, Eduardo Collantes-Estévez Grant/research support from: ROCHE and Pfizer., Speakers bureau: ROCHE, Lilly, Bristol and Celgene., Jordi Gratacos-Masmitja Grant/research support from: a grant from Pfizzer to study implementation of multidisciplinary units to manage PSA in SPAIN, Consultant of: Pfizzer, MSD, ABBVIE, Janssen, Amgen, BMS, Novartis, Lilly, Speakers bureau: Pfizzer, MSD, ABBVIE, Janssen, Amgen, BMS, Novartis, Lilly

Ugandan and South African contemporary women’s narratives reflect on the rapid pace of change in the social lives of women in two countries that are contending with the aftermath of conflict and violence. This article will interrogate how contemporary women writers such as Goretti Kyomuhendo ( Whispers from Vera), Zukiswa Wanner ( The Madams and Behind Every Successful Man) and Cynthia Jele ( Happiness is a Four-Letter Word) are embracing chick-lit as a form of writing, while simultaneously short-circuiting this genre to create an experimental form that allows them to reflect on the realities of women and engage with the contradictions, complexities and ambiguities of contemporary feminine subjectivities. Although chick-lit as a genre has been dismissed as trivial and frivolous, ostensibly because it deals with women’s experiences, this article argues that this particular form of chick-lit is more political and attempts to disrupt the original chick-lit by offering a critique of society. It articulates how women see themselves and their relationships with their parents, spouses and, most importantly, female friends; reflects on the challenges that modern women face in the work environment; interrogates women’s realities concerning love, marriage and motherhood; explores concepts of sexual desire and intimacy; and negotiates the dilemmas of a patriarchal society, while also confronting issues of class and race. These contemporary women writers are adopting this genre because it allows them to reflect on realities that are complex and uncertain, to transform gender relations, to redefine the roles of women and to construct new feminine subjectivities.

Purpose The purpose of this paper is to establish the mediating effect of financial literacy in the relationship between institutional framing and financial inclusion among poor households in Uganda with a specific focus on Mokono district. Design/methodology/approach The study adopted a cross-sectional design. Data were analyzed using structural equation modeling (SEM), which adopted Analysis of Moment Structures to test for mediating effect of financial literacy in the relationship between institutional framing and financial inclusion. Findings The results revealed that financial literacy had a partial mediating effect in the relationship between institutional framing and financial inclusion. Furthermore, the results indicated that while institutional framing has a direct effect on financial inclusion, it also exerts an indirect effect through financial literacy. This supports the argument that institutional framing that structure the way how poor households interpret, evaluate, comprehend and make sound financial decisions and choices, is enhanced by knowledge and skills acquired through financial literacy by poor households. Research limitations/implications This study has been limited by adopting only cross-sectional design and quantitative research approach, therefore ignoring longitudinal design and qualitative research approach. Besides, the study uses SEM bootstrap approach and ignores MedGraph method, which is also recommended for testing mediation. Practical implications Since the results suggest that institutional framing of poor households are partially enhanced by financial literacy to increase financial inclusion, policy makers, practitioners and managers of financial institutions should ensure extending financial literacy programs closer to the poor in order to expand the scope of financial inclusion beyond the current sphere. Indeed, financial literacy programs will boost cognitive abilities of poor households resulting into better financial decisions and choices and, hence increase in demand and consumption of financial services. Originality/value The study significantly generates empirical evidence by testing the mediating role of financial literacy in the relationship between institutional framing and financial inclusion using SEM bootstrap approach. The study portrays the influential partial effect of financial literacy in enhancing institutional frames of poor households in order to cause improvement in financial inclusion. Indeed, financial literacy programs that entail acquisition of financial knowledge and skills boost cognitive abilities of poor households to easily interpret, evaluate, comprehend meanings, and take correct decisions and actions on financial matters. The mediating effect of financial literacy in the relationship between institutional framing and financial inclusion seems to be lacking in literature and theory. Thus, the paper is the first to relate the influential partial effect of financial literacy in the relationship between institutional framing and financial inclusion among poor households, especially in a developing country context.

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.

Abstract The role of biological sex on clinical outcomes and the pathogenesis of AIDS-related opportunistic infections is unknown. We assessed baseline biomarkers and outcomes between 577 men and 400 women in HIV-related cryptococcal meningitis cohorts in Uganda and South Africa from 2010 to 2017. We compared 10-week mortality by sex via Cox proportional hazards models. The 10-week mortality for women was 50% (198/400) and 43% (247/577) for men. Women had higher risk of death in an unadjusted model (Hazard Ratio (HR) = 1.20; 95%CI, 1.00–1.45; P = .05). Women maintained a higher risk when adjusting for quantitative CSF culture, altered mental status, CSF pleocytosis, age, and antiretroviral status (HR = 1.31; 95%CI, 1.07–1.59; P &lt; .01). However, after adjusting for hemoglobin, the risk of death did not differ between women and men (HR = 1.17; 95%CI, 0.94–1.45; P = .17). Moderate to severe anemia (hemoglobin &lt; 8.5 g/dL) was present among 16% (55/355) of women and 10% (55/532) of men (P = .02). Of the 373 participants with CSF biomarkers, men had higher median pro- and anti-inflammatory, monocyte/macrophage differentiation, maturation, and migration, immune exhaustion, and cytotoxicity cytokines than women (P &lt; .05). We identified biological sex as proxy for anemia, a potentially modifiable risk factor for cryptococcal meningitis mortality. Immune response may contribute to the multifaceted underlying mechanisms for the discrepancy in mortality based on sex. Lay Summary We examined the role of biological sex in cryptococcal meningitis mortality in a large cohort. Our findings reveal significant differences in inflammatory markers by biological sex. Women have significantly higher mortality due to cryptococcal meningitis that is attributable to anemia at baseline.

AbstractHuman immunodeficiency virus (HIV) infection remains a significant public health burden globally. The role of viral co-infection in the rate of progression of HIV infection has been suggested but not empirically tested, particularly among children. We extracted and classified 42 viral species from whole-exome sequencing (WES) data of 813 HIV-infected children in Botswana and Uganda categorised as either long-term non-progressors (LTNPs) or rapid progressors (RPs). The Ugandan participants had a higher viral community diversity index compared to Batswana (p = 4.6 × 10−13), and viral sequences were more frequently detected among LTNPs than RPs (24% vs 16%; p = 0.008; OR, 1.9; 95% CI, 1.6–2.3), with Anelloviridae showing strong association with LTNP status (p = 3 × 10−4; q = 0.004, OR, 3.99; 95% CI, 1.74–10.25). This trend was still evident when stratified by country, sex, and sequencing platform, and after a logistic regression analysis adjusting for age, sex, country, and the sequencing platform (p = 0.02; q = 0.03; OR, 7.3; 95% CI, 1.6–40.5). Torque teno virus (TTV), which made up 95% of the Anelloviridae reads, has been associated with reduced immune activation. We identify an association between viral co-infection and prolonged AIDs-free survival status that may have utility as a biomarker of LTNP and could provide mechanistic insights to HIV progression in children, demonstrating the added value of interrogating off-target WES reads in cohort studies.

BackgroundSchool attendance rates in sub-Saharan Africa are among the lowest worldwide, placing children at heightened risk for poor educational and economic outcomes. One understudied risk factor for missed schooling is household water insecurity, which is linked to depression among women and may increase children's water-fetching burden at the expense of educational activities, particularly among children of depressed caregivers. In this study conducted in rural Uganda, we assessed the association between household water insecurity and child school participation and the mediating pathways behind these associations.MethodWe conducted a population-based, cross-sectional study of female household heads (N = 257) and their children ages 5–17 (N = 551) in the rural regions surrounding the town of Mbarara, in southwestern Uganda. We used multivariable linear regressions to estimate the association between water insecurity and missed schooling. We then assessed the extent to which the association was mediated by caregiver depression.ResultsAmong children, water insecurity had a statistically significant association with the number of missed school days (a standard deviation increase in water insecurity resulted in 0.30 more missed school days in the last week). The estimated association was partially mediated by caregiver depression. When stratified by sex, this mediating pathway remained significant for boys, but not among girls.ConclusionsWater insecurity is a risk factor for missed schooling among children in rural Uganda. Caregiver depression partially mediated this relationship. Also addressing caregiver mental health in water insecure families may more fully address the needs of sub-Saharan African families and promote educational participation among youth.

After a realisation that there are scanty studies conducted on university teachers trainees’ sexual experiences and how these experiences are shaped by gender, age and religion, this study set out to conduct survey on final/third year university teacher-trainees in two selected teacher training university colleges, one in Uganda and another in Tanzania, with the purpose of examining the role of gender, age and religion in explaining the variations in age of first sexual experience and number of both past and current sexual partners among the university teacher-trainees. The purely quantitative study was conducted on a population of 557 teacher-trainees who were selected that the students studied were drawn from a sample taken from a population using systematic random sampling. The teacher-trainees were final/third year students at both Makerere University’s College of Education and External Studies (MUK) and University of Dar es Salaam’s Constituent College of Education known as Dar es Salaam University College of Education (UDSM). The observed scores and resultant variations revealed that the variation in age of first sexual experience among male and female and male teacher trainees was non-significant while the variation in number of both past and current sexual partners among the two genders was significant. The variation in age of first sexual experience among the age groups was significant while the variation in number of both past and current sexual partners among the existing age groups was non-significant. The variation in age of first sexual experience, number of past and current sexual partners among the existing religions was non-significant all through. Basing on these findings therefore, it is recommended that sex education and policies be introduced in high institutions of learning while stressing education on contraception and messages about sex. Religious leaders too should participate in teaching against behaviours that lead to consequences of early sex debut and existence of concurrent multiple sexual partners among young people.

AbstractThe Abrahamic faiths and received colonial law have been identified as the driving force behind the criminalisation of homosexual activity in most of the Commonwealth States of Africa. This article, therefore, seeks to question the role of criminal law in proscribing sexual activities amongst consenting adults of the same gender in Commonwealth African states. A recurring question in the paper is the propriety of criminalising a consensual conduct amongst consenting adults in private when no harm or injury is done to other citizens or the state in line with JS Mill’s principle of harm. The article finds that the misconception that the main aim of criminal law is to legislate the moral values of the majority, forms support for the view that homosexuality can be learned and unlearned and if this is the case, a paternalistic approach by the state would help mould citizens’ behaviour. A comparative and case study approach was adopted for the discussion in the article. Four Commonwealth African states, namely, Ghana, Kenya, Nigeria and Uganda were selected as case studies. The article recommends a much more robust approach for the support of sexual minorities in the Commonwealth.

Abstract Background Growing evidence shows that social accountability contributes to improving health care services, with much promise for addressing women’s barriers in contraceptive care. Yet little is known about how social accountability works in the often-complex context of sexual and reproductive health, particularly as sex and reproduction can be sensitive topics in the open and public formats typical of social accountability. This paper explores how social accountability operates in the highly gendered and complex context of contraceptive care. Methods This exploratory research uses a case study approach to provide a more grounded understanding of how social accountability processes operate in the context of contraceptive information and services. We observed two social accountability projects that predominantly focused on contraceptive care in Uganda over a year. Five instruments were used to capture information from different source materials and multiple respondents. In total, one hundred and twenty-eight interviews were conducted and over 1000 pages of project documents were collected. Data were analyzed and compiled into four case studies that provide a thick description of how these two projects operated. Results The case studies show the critical role of information, dialogue and negotiation in social accountability in the context of contraceptive care. Improved community and health system relationships, community empowerment, provider and health system responsiveness and enhanced availability and access to services were reported in both projects. There were also changes in how different actors related to themselves and to each other, and contraceptive care, a previously taboo topic, became a legitimate area for public dialogue. Conclusion The study found that while social accountability in the context of contraceptive services is indeed sensitive, it can be a powerful tool to dissolving resistance to family planning and facilitating a more productive discourse on the topic.

AbstractThe study of free-living animal populations is necessary to understand life history trade-offs associated with immune investment. To investigate the role of life history strategies in shaping proinflammatory cell-mediated immune function, we analyzed age, sex, and reproductive status as predictors of urinary neopterin in 70 sexually mature chimpanzees (Pan troglodytes) at Ngogo, Kibale National Park, Uganda. In the absence of clinical signs of acute infectious disease, neopterin levels significantly increased with age in both male and female chimpanzees, as observed in humans and several other vertebrate species. Furthermore, males exhibited higher neopterin levels than females across adulthood. Finally, females with full sexual swellings, pregnant females, and post-reproductive females, the oldest individuals in our sample, exhibited higher neopterin levels than lactating females and cycling females without full swellings. Variation in females’ neopterin levels by reproductive status is consistent with post-ovulatory and pregnancy-related immune patterns documented in humans. Together, our results provide evidence of ample variation in chimpanzee immune activity corresponding to biodemographic and physiological variation. Future studies comparing immune activity across ecological conditions and social systems are essential for understanding the life histories of primates and other mammals.

Dogs play a major role in public health because of potential transmission of zoonotic diseases, such as rabies. Dog roaming behavior has been studied worldwide, including countries in Asia, Latin America, and Oceania, while studies on dog roaming behavior are lacking in Africa. Many of those studies investigated potential drivers for roaming, which could be used to refine disease control measures. However, it appears that results are often contradictory between countries, which could be caused by differences in study design or the influence of context-specific factors. Comparative studies on dog roaming behavior are needed to better understand domestic dog roaming behavior and address these discrepancies. The aim of this study was to investigate dog demography, management, and roaming behavior across four countries: Chad, Guatemala, Indonesia, and Uganda. We equipped 773 dogs with georeferenced contact sensors (106 in Chad, 303 in Guatemala, 217 in Indonesia, and 149 in Uganda) and interviewed the owners to collect information about the dog [e.g., sex, age, body condition score (BCS)] and its management (e.g., role of the dog, origin of the dog, owner-mediated transportation, confinement, vaccination, and feeding practices). Dog home range was computed using the biased random bridge method, and the core and extended home range sizes were considered. Using an AIC-based approach to select variables, country-specific linear models were developed to identify potential predictors for roaming. We highlighted similarities and differences in term of demography, dog management, and roaming behavior between countries. The median of the core home range size was 0.30 ha (95% range: 0.17–0.92 ha) in Chad, 0.33 ha (0.17–1.1 ha) in Guatemala, 0.30 ha (0.20–0.61 ha) in Indonesia, and 0.25 ha (0.15–0.72 ha) in Uganda. The median of the extended home range size was 7.7 ha (95% range: 1.1–103 ha) in Chad, 5.7 ha (1.5–27.5 ha) in Guatemala, 5.6 ha (1.6–26.5 ha) in Indonesia, and 5.7 ha (1.3–19.1 ha) in Uganda. Factors having a significant impact on the home range size in some of the countries included being male dog (positively), being younger than one year (negatively), being older than 6 years (negatively), having a low or a high BCS (negatively), being a hunting dog (positively), being a shepherd dog (positively), and time when the dog was not supervised or restricted (positively). However, the same outcome could have an impact in a country and no impact in another. We suggest that dog roaming behavior is complex and is closely related to the owner's socioeconomic context and transportation habits and the local environment. Free-roaming domestic dogs are not completely under human control but, contrary to wildlife, they strongly depend upon humans. This particular dog–human bound has to be better understood to explain their behavior and deal with free-roaming domestic dogs related issues.

Since its emergence in 1983, public health professionals have been working to effectively prevent the transmission of HIV. The ABC method or prevention, referring to promotion of abstinence, condoms and being faithful, has been employed extensively throughout sub-Saharan Africa. Contrastingly, the Belizean epidemic has received very little attention from ABC researchers. Although some research exists looking into the determinants of sexual HIV transmission in Belize, very little is understood about the cultural norms that perpetuate these factors. In order to make recommendations for the efficient implementation of ABC programs in Belize, case studies from Botswana, Zaire and Uganda will be used to review past experiences of ABC in Africa, and identify the cultural challenges faced in their implementation. Case studies found that programs that relied heavily on abstinence and condom promotion did not work well in these contexts due to opposing views of sexuality, while balanced programs that emphasized being faithful were more successful within these cultures. Ethnographic research is needed to fill knowledge gaps regarding Belizean sexuality. Namely, future research should seek to understand the male view of sexuality in particular, as well as differences in generational views of sex. Public health workers should also aim to create programs that engage the community in order to build trust, as well as understand the role of community leaders and celebrities in influencing local views of sex. These insights provide future researchers a starting point for building effective ABC programs that work within the given culture rather than against it.

In Africa, the emergence of a “modern” mental health regime centered on psychiatry is often portrayed as a unidirectional intervention by “the West.” Analyses ranging from medical histories of colonial psychiatry to more recent studies of Global Mental Health focus mostly on the role of external actors and the ways their actions impact(ed) on local populations. Uncritical studies simply reduce the complexity of African therapeutic landscapes to a “treatment gap” and see the introduction of “science-based” mental health approaches as necessary “civilizing” missions. Critical studies emphasize the harms of psychiatric interventions and celebrate local healing practices instead. Both approaches are problematic: they ignore the many interconnections between highly dynamic treatment regimes that cannot be neatly designated as African or western, portray local populations as largely passive, and neglect the multiple ways in which psychiatry has been embraced, adapted, and disrupted by Africans themselves. This article challenges simplistic depictions of “western” psychiatry in Africa by providing a portrait of Rwashana Selina, the first Ugandan psychiatric nurse who—after being sent to the UK in the 1950s for training—became a central figure in Ugandan psychiatry. Based on interview material, I recount her life story and discuss her formative role in the development of psychiatric care in the colonial and postcolonial era. Rwashana's tale of Ugandan psychiatry emphasizes co-operation, mutual acknowledgments and pluralistic leadership and thus breaks with typical images of and dichotomies between white doctors and supposedly inferior African medical staff.

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.

PurposeThe purpose of this paper is twofold. First, it intends to explore the link between internal social capital, logistics capabilities, supply chain risk management (SCRM) capabilities and supplier performance. Second, the mediating effect of logistics capabilities between internal social capital and SCRM capabilities, and that of SCRM capabilities between logistics capabilities and supplier performance are also examined.Design/methodology/approachA theoretical model developed from the extant literature was empirically validated through a cross-sectional survey of 122 respondents in 52 public healthcare facilities in Uganda. The data were analysed using partial least square structural equation modeling (PLS-SEM).FindingsThe study found that internal social capital and SCRM capabilities are significant predictors of supplier performance. Internal social capital is positively and significantly related to logistics capabilities, and logistics capabilities are positively and significantly related to SCRM capabilities. The authors also found non-significant relationships between internal social capital and SCRM capabilities, and between logistics capabilities and supplier performance. Furthermore, it was revealed that logistics capabilities play a partial mediating role in the relationship between internal social capital and SCRM capabilities, while SCRM capabilities fully mediate between logistics capabilities and supplier performance.Originality/valueFurther to providing empirical evidence of the antecedents of supplier performance in the public healthcare in a developing economy, which has been evidently scant, this study provides initial empirical evidence of the mediating role of logistics capabilities in the relationship between internal social capital and SCRM capabilities and that of SCRM capabilities in the relationship between logistics capabilities and supplier performance. This is important for understanding the mechanism through which supplier performance can be enhanced.

Abstract Background Left ventricular systolic dysfunction (LVSD) is associated with increased morbidity and mortality. Although there are effective treatments for patients with LVSD to prevent mortality, heart failure and to improve symptoms, many patients remain undetected and untreated. We have recently derived a deep learning algorithm to detect LVSD using the electrocardiogram (ECG) which could have an important screening role, particularly in limited resources settings. We evaluated the accuracy of this algorithm for the first time in Africa in a sample of subjects attending a cardiology clinic. Methods We conducted a retrospective study in a general cardiac clinic in Uganda. Consecutive patients ≥18 years who had a digital ECG and echocardiogram done within two days of each other were included. We excluded patients with pacemakers or missing information regarding left ventricular ejection fraction (LVEF). Routine 10-second, twelve-lead surface rest ECG were performed using an Edan PC ECG Model SE-1515, Hamburg, Germany. The probability of LVSD was estimated with the Mayo Clinic artificial intelligence (AI) ECG algorithm. LVEF was calculated by the MMode (Teichholz method) using a Philips Ultrasound system, HD7XE, Bothel, Washington, USA. LVSD was defined as a LVEF≤35%. We assessed the overall diagnostic performance of the algorithm to identify LVSD in this population with the area under the receiver operating curve (AUC), and estimated sensitivity, specificity and accuracy using a pre-specified cut-off based on the probability for LVSD generated by the algorithm. We conducted secondary analyses using different LVEF cutoff values. Results We included 634 subjects, 32% (200) of whom had hypertension and 12% (77) clinical heart failure. Mean age was 57±18.8 years, 58% were women and the overall prevalence of LVSD was 4%. The AI-ECG had an AUC of 0.866 (see figure below), sensitivity 73.08%, specificity 91.10%, negative predictive value 98.75%, positive predictive value 26.03% and an accuracy of 90.96% using the original threshold. Using the optimal cutoff based on the AUCs, the sensitivity was 80.77% and specificity was 81.05% with a negative predictive value of 98.99%. The ROC for the detection of LVEF of 40% or below was 0.821. Conclusion The Mayo AI-ECG algorithm demonstrated good accuracy, sensitivity and specificity to detect LVSD in patients seen in a clinical setting in Uganda. This tool may facilitate the identification of people at a high risk for LVSD in settings with low resources. ROC Funding Acknowledgement Type of funding source: None

Helen Harrison in her opening editorial in issue number 2 of the IASA Journal notes, “...on no account should we be complacent about the Journal or other IASA publications, ideas for change are always welcome and material for inclusion even more so.” She was contemplating the state of the Journal on the heels of its transformation from the Phonographic Bulletin (1971–1993) to the IASA Journal (1993–present). The name had changed, but Harrison took the role of editor with ideas for additional improvements to the structure, content, operation, and aesthetics of the Journal; and she found herself also faced with the task of developing a new reputation for the newly minted IASA Journal. That was 26 years ago, and the IASA Journal has now been the IASA Journal longer than it was the Phonographic Bulletin. The transformation, we can say, was a success. Today, in 2018, as editor, I face a similar challenge: whether to transform the IASA Journal to an e-Journal, and whether to push for an open access model for content in the IASA Journal. These are two slightly independent changes that I am proposing for the Journal, and both have a variety of options associated with them. The IASA Journal as an e-Journal When we think about the IASA Journal as an electronic journal, we can consider it with or without a printed version. At one extreme, we can imagine an online platform that serves as the only access point to IASA Journal publications. Such a platform can provide a variety of discovery and access options for IASA Journal content, including text-based search, author indexes, online reading via PDF or HTML, syndication for subscribers, and API access for data aggregators, among others. We can also imagine these online access options with additional options for printed issues, either “on-demand” or in small batches. At the opposite extreme, we could imagine the same full print scenario we have today with the addition of an online access point with the options I mention above (although, this option, of course, requires the greatest cost to the organization). These are the types of options we are considering as we develop a strategy for moving the IASA Journal to an online home. The IASA Journal as an Open Access Journal A related question, once the Journal has an e-Journal access point, is whether the content of the IASA Journal should remain closed to the World, open only to IASA members and subscribers, for five years after its publication. This has been, and still is, the policy of the IASA Journal. But, should it be? Does such a policy support the central mission of IASA, as stated in its constitution, “to promote, encourage, and support the development of best professional standards and practice in all countries through communication, cooperation, advocacy, promulgation, dissemination, training and/or education, amongst public or private archives or libraries, institutions, businesses, organisations and associations which share these purposes?” Could we, as an organization, do better to disseminate the writings in the Journal to the global audiovisual archives community? Could we, instead of using the content as bait for membership, rather use the content as a shared resource that enriches IASA’s network and entices new members to the organization? Launching an e-Journal does not require IASA to provide Open Access to the content; it merely offers the opportunity, and because of that, I think it valuable to have the conversation. So, these are the types of access questions that we are also considering as we develop a strategy for the IASA Journal online platform. If you, as a IASA member or subscriber, have thoughts on these topics, please feel free to reach out to me at editor@iasa-web.org. I am eager to hear from you. The Issue at Hand This issue, our third peer-reviewed issue, features a wide variety of topics important to the audiovisual archives communities today, including digital preservation, born-digital video, contemporary memories, diversification of the archive(s), repatriation of colonial and radio collections, and building stronger connections between archives and users of archival collections. The issue commences with three profiles highlighting the human labor that underlies all archives and archival collections. In Ghana, Judith Opoku-Boateng interviews J. H. Kwabena Nketia about his work recording the songs and interviews that would become the cross-cultural foundation for the J. H. Kwabena Nketia Archives of the Institute for African Studies at the University of Ghana. In Australia, Melinda Barrie talks with sound scholar Robyn Holmes about her lifelong passion to dissemination and document Australian music. And, in Italy, Ettore Pacetti and Daniela Floris discuss the pioneering fieldwork of the Italian ethnomusicologist, Diego Carpitella, and how his efforts laid the seeds for the current project of the Audiovisual Archives at RAI Teche to bring Italian cultural heritage to a worldwide audience. Paul Conway and Kelly Askew, both of the University of Michigan, provide a glimpse into efforts to organize, describe, and “re-broadcast” content from Voice of America’s radio program Music Time in Africa to new audiences. Conway and Askew contextualize the issues associated with providing access to cultural heritage resources, and conclude with a proposal for a proactive strategy for online dissemination. Approaching the topic of repatriation of cultural heritage from another angle, Diane Thram, from the International Library of African Music in South Africa, articulates the effort that she and her colleagues undertook to hand-deliver (or, digitally return) recorded copies of performances to musicians across the African continent. Beginning with Uganda, and then Kenya, Thram and colleagues located performers and descendents from recordings made by Hugh Tracey and coordinated visits to return and re-study the music and performances that had been recorded more than 50 years ago with musicians in these locales. Together, these two articles offer a thorough glimpse into the theory and practice of post-colonial archival practice. Reformulating a talk that was delivered at this year’s IASA conference in Berlin, Gisa Jähnichen of the Shanghai Conservatory of Music in China, along with colleagues Ahmad Faudzi Musib (Malaysia), Thongbang Homsombat (Laos), Chinthaka Prageeth Meddegooda (Sri Lanka), and Xiao Mei (China), take a close look at the successes and failures they see in the small-scale audiovisual archives where they work in China, Malaysia, Laos, and Sri Lanka. The work of these authors lays a foundation for conversations about how to ensure that audiovisual archives maintain living networks and continue to develop capacity within and outside of the archives themselves. If smaller archives in Asia are to sustain themselves in the digital present, what are the key issues that must be addressed? And, what can archives in other regions of the world learn from this study? The remaining articles in this issue move from questions of the management of archives, to technical questions about the digital infrastructures and digital formats that we are facing in audiovisual archives today. Silvester Stöger, from NOA in Austria, looks at the needs of broadcast archives with regard to production and preservation workflows, describing the values of an archive asset management system that can integrate with other business systems in a broadcast environment. Iain Richardson, from Vcodex, Ltd. in the UK, illustrates the lossy process of data reduction as a compression technique in digital video, offering insight into quantitative and qualitative methods to compare quality in digital video objects. From the Alexander Turnbull Library, National Library of New Zealand, Valerie Love describes the changes that the acquisition of born-digital content, specifically oral history content, has brought to the archive’s standard operating procedures. Wrapping up this issue, Ariane Gervásio, from the Brazilian Association of Audiovisual Archives, challenges readers to re-imagine the concept of personal memories in today’s transmedia world, where traditional concepts of content and media—e.g., a song exists as a single recording in a single place—must be understood as a multifarious entity, perhaps existing initially as a video posted to one web platform, yet then interacted with by users in another web platform, leaving a complex trail of engagement that ultimately constitutes the object that will be collected by an archive. Are we, as audiovisual archivists, ready to conceive of contemporary born-digital content in this way? Do we have a choice? I look forward to hearing your thoughts on the contents of this Issue, as well as on the future of the IASA Journal. Bertram Lyons, CAIASA Editor

Introduction Documentary film has grown significantly in the past decade, with high profile films such as Fahrenheit 9/11, Supersize Me, and An Inconvenient Truth garnering increased attention both at the box office and in the news media. In addition, the rising prominence of web-based media has provided new opportunities for documentary to create social impact. Films are now typically released with websites, Facebook pages, twitter feeds, and web videos to increase both reach and impact. This combination of technology and broader audience appeal has given rise to a current landscape in which documentary films are imbedded within coordinated multi-media campaigns. New media have not only opened up new avenues for communicating with audiences, they have also created new opportunities for data collection and analysis of film impacts. A recent report by McKinsey and Company highlighted this potential, introducing and discussing the implications of increasing consumer information being recorded on the Internet as well as through networked sensors in the physical world. As they found: "Big data—large pools of data that can be captured, communicated, aggregated, stored, and analyzed—is now part of every sector and function of the global economy" (Manyika et al. iv). This data can be mined to learn a great deal about both individual and cultural response to documentary films and the issues they represent. Although film has a rich history in humanities research, this new set of tools enables an empirical approach grounded in the social sciences. However, several researchers across disciplines have noted that limited investigation has been conducted in this area. Although there has always been an emphasis on social impact in film and many filmmakers and scholars have made legitimate (and possibly illegitimate) claims of impact, few have attempted to empirically justify these claims. Over fifteen years ago, noted film scholar Brian Winston commented that "the underlying assumption of most social documentaries—that they shall act as agents of reform and change—is almost never demonstrated" (236). A decade later, Political Scientist David Whiteman repeated this sentiment, arguing that, "despite widespread speculation about the impact of documentaries, the topic has received relatively little systematic attention" ("Evolving"). And earlier this year, the introduction to a special issue of Mass Communication and Society on documentary film stated, "documentary film, despite its growing influence and many impacts, has mostly been overlooked by social scientists studying the media and communication" (Nisbet and Aufderheide 451). Film has been studied extensively as entertainment, as narrative, and as cultural event, but the study of film as an agent of social change is still in its infancy. This paper introduces a systematic approach to measuring the social impact of documentary film aiming to: (1) discuss the context of documentary film and its potential impact; and (2) argue for a social science approach, discussing key issues about conducting such research. Changes in Documentary Practice Documentary film has been used as a tool for promoting social change throughout its history. John Grierson, who coined the term "documentary" in 1926, believed it could be used to influence the ideas and actions of people in ways once reserved for church and school. He presented his thoughts on this emerging genre in his 1932 essay, First Principles of Documentary, saying, "We believe that the cinema's capacity for getting around, for observing and selecting from life itself, can be exploited in a new and vital art form" (97). Richard Barsam further specified the definition of documentary, distinguishing it from non-fiction film, such that all documentaries are non-fiction films but not all non-fiction films are documentaries. He distinguishes documentary from other forms of non-fiction film (i.e. travel films, educational films, newsreels) by its purpose; it is a film with an opinion and a specific message that aims to persuade or influence the audience. And Bill Nichols writes that the definition of documentary may even expand beyond the film itself, defining it as a "filmmaking practice, a cinematic tradition, and mode of audience reception" (12). Documentary film has undergone many significant changes since its inception, from the heavily staged romanticism movement of the 1920s to the propagandist tradition of governments using film to persuade individuals to support national agendas to the introduction of cinéma vérité in the 1960s and historical documentary in the 1980s (cf. Barnouw). However, the recent upsurge in popularity of documentary media, combined with technological advances of internet and computers have opened up a whole new set of opportunities for film to serve as both art and agent for social change. One such opportunity is in the creation of film-based social action campaigns. Over the past decade, filmmakers have taken a more active role in promoting social change by coordinating film releases with action campaigns. Companies such as Participant Media (An Inconvenient Truth, Food Inc., etc.) now create "specific social action campaigns for each film and documentary designed to give a voice to issues that resonate in the films" (Participant Media). In addition, a new sector of "social media" consultants are now offering services, including "consultation, strategic planning for alternative distribution, website and social media development, and complete campaign management services to filmmakers to ensure the content of nonfiction media truly meets the intention for change" (Working Films). The emergence of new forms of media and technology are changing our conceptions of both documentary film and social action. Technologies such as podcasts, video blogs, internet radio, social media and network applications, and collaborative web editing "both unsettle and extend concepts and assumptions at the heart of 'documentary' as a practice and as an idea" (Ellsworth). In the past decade, we have seen new forms of documentary creation, distribution, marketing, and engagement. Likewise, film campaigns are utilizing a broad array of strategies to engage audience members, including "action kits, screening programs, educational curriculums and classes, house parties, seminars, panels" that often turn into "ongoing 'legacy' programs that are updated and revised to continue beyond the film's domestic and international theatrical, DVD and television windows" (Participant Media). This move towards multi-media documentary film is becoming not only commonplace, but expected as a part of filmmaking. NYU film professor and documentary film pioneer George Stoney recently noted, "50 percent of the documentary filmmaker's job is making the movie, and 50 percent is figuring out what its impact can be and how it can move audiences to action" (qtd. in Nisbet, "Gasland"). In his book Convergence Culture, Henry Jenkins, coined the term "transmedia storytelling", which he later defined as "a process where integral elements of a fiction get dispersed systematically across multiple delivery channels for the purpose of creating a unified and coordinated entertainment experience" ("Transmedia"). When applied to documentary film, it is the elements of the "issue" raised by the film that get dispersed across these channels, coordinating, not just an entertainment experience, but a social action campaign. Dimensions of Evaluation It is not unreasonable to assume that such film campaigns, just like any policy or program, have the possibility to influence viewers' knowledge, attitudes, and behavior. Measuring this impact has become increasingly important, as funders of documentary and issue-based films want look to understand the "return on investment" of films in terms of social impact so that they can compare them with other projects, including non-media, direct service projects. Although we "feel" like films make a difference to the individuals who also see them in the broader cultures in which they are embedded, measurement and empirical analysis of this impact are vitally important for both providing feedback to filmmakers and funders as well as informing future efforts attempting to leverage film for social change. This type of systematic assessment, or program evaluation, is often discussed in terms of two primary goals—formative (or process) and summative (or impact) evaluation (cf. Muraskin; Trochim and Donnelly). Formative evaluation studies program materials and activities to strengthen a program, and summative evaluation examines program outcomes. In terms of documentary film, these two goals can be described as follows: Formative Evaluation: Informing the Process As programs (broadly defined as an intentional set of activities with the aim of having some specific impact), the people who interact with them, and the cultures they are situated in are constantly changing, program development and evaluation is an ongoing learning cycle. Film campaigns, which are an intentional set of activities with the aim of impacting individual viewers and broader cultures, fit squarely within this purview. Without formulating hypotheses about the relationships between program activities and goals and then collecting and analyzing data during implementation to test them, it is difficult to learn ways to improve programs (or continue doing what works best in the most efficient manner). Attention to this process enables those involved to learn more about, not only what works, but how and why it works and even gain insights about how program outcomes may be affected by changes to resource availability, potential audiences, or infrastructure. Filmmakers are constantly learning and honing their craft and realizing the impact of their practice can help the artistic process. Often faced with tight budgets and timelines, they are forced to confront tradeoffs all the time, in the writing, production and post-production process. Understanding where they are having impact can improve their decision-making, which can help both the individual project and the overall field. Summative Evaluation: Quantifying Impacts Evaluation is used in many different fields to determine whether programs are achieving their intended goals and objectives. It became popular in the 1960s as a way of understanding the impact of the Great Society programs and has continued to grow since that time (Madaus and Stufflebeam). A recent White House memo stated that "rigorous, independent program evaluations can be a key resource in determining whether government programs are achieving their intended outcomes as well as possible and at the lowest possible cost" and the United States Office of Management and Budget (OMB) launched an initiative to increase the practice of "impact evaluations, or evaluations aimed at determining the causal effects of programs" (Orszag 1). Documentary films, like government programs, generally target a national audience, aim to serve a social purpose, and often do not provide a return on their investment. Participant Media, the most visible and arguably most successful documentary production company in the film industry, made recent headlines for its difficulty in making a profit during its seven-year history (Cieply). Owner and founder Jeff Skoll reported investing hundreds of millions of dollars into the company and CEO James Berk added that the company sometimes measures success, not by profit, but by "whether Mr. Skoll could have exerted more impact simply by spending his money philanthropically" (Cieply). Because of this, documentary projects often rely on grant funding, and are starting to approach funders beyond traditional arts and media sources. "Filmmakers are finding new fiscal and non-fiscal partners, in constituencies that would not traditionally be considered—or consider themselves—media funders or partners" (BRITDOC 6). And funders increasingly expect tangible data about their return on investment. Says Luis Ubiñas, president of Ford Foundation, which recently launched the Just Films Initiative: In these times of global economic uncertainty, with increasing demand for limited philanthropic dollars, assessing our effectiveness is more important than ever. Today, staying on the frontlines of social change means gauging, with thoughtfulness and rigor, the immediate and distant outcomes of our funding. Establishing the need for evaluation is not enough—attention to methodology is also critical. Valid research methodology is a critical component of understanding around the role entertainment can play in impacting social and environmental issues. The following issues are vital to measuring impact. Defining the Project Though this may seem like an obvious step, it is essential to determine the nature of the project so one can create research questions and hypotheses based on a complete understanding of the "treatment". One organization that provides a great example of the integration of documentary film imbedded into a larger campaign or movement is Invisible Children. Founded in 2005, Invisible Children is both a media-based organization as well as an economic development NGO with the goal of raising awareness and meeting the needs of child soldiers and other youth suffering as a result of the ongoing war in northern Uganda. Although Invisible Children began as a documentary film, it has grown into a large non-profit organization with an operating budget of over $8 million and a staff of over a hundred employees and interns throughout the year as well as volunteers in all 50 states and several countries. Invisible Children programming includes films, events, fundraising campaigns, contests, social media platforms, blogs, videos, two national "tours" per year, merchandise, and even a 650-person three-day youth summit in August 2011 called The Fourth Estate. Individually, each of these components might lead to specific outcomes; collectively, they might lead to others. In order to properly assess impacts of the film "project", it is important to take all of these components into consideration and think about who they may impact and how. This informs the research questions, hypotheses, and methods used in evaluation. Film campaigns may even include partnerships with existing social movements and non-profit organizations targeting social change. The American University Center for Social Media concluded in a case study of three issue-based documentary film campaigns: Digital technologies do not replace, but are closely entwined with, longstanding on-the-ground activities of stakeholders and citizens working for social change. Projects like these forge new tools, pipelines, and circuits of circulation in a multiplatform media environment. They help to create sustainable network infrastructures for participatory public media that extend from local communities to transnational circuits and from grassroots communities to policy makers. (Abrash) Expanding the Focus of Impact beyond the Individual A recent focus has shifted the dialogue on film impact. Whiteman ("Theaters") argues that traditional metrics of film "success" tend to focus on studio economic indicators that are far more relevant to large budget films. Current efforts focused on box office receipts and audience size, the author claims, are really measures of successful film marketing or promotion, missing the mark when it comes to understanding social impact. He instead stresses the importance of developing a more comprehensive model. His "coalition model" broadens the range and types of impact of film beyond traditional metrics to include the entire filmmaking process, from production to distribution. Whiteman (“Theaters”) argues that a narrow focus on the size of the audience for a film, its box office receipts, and viewers' attitudes does not incorporate the potential reach of a documentary film. Impacts within the coalition model include both individual and policy levels. Individual impacts (with an emphasis on activist groups) include educating members, mobilizing for action, and raising group status; policy includes altering both agenda for and the substance of policy deliberations. The Fledgling Fund (Barrett and Leddy) expanded on this concept and identified five distinct impacts of documentary film campaigns. These potential impacts expand from individual viewers to groups, movements, and eventually to what they call the "ultimate goal" of social change. Each is introduced briefly below. Quality Film. The film itself can be presented as a quality film or media project, creating enjoyment or evoking emotion in the part of audiences. "By this we mean a film that has a compelling narrative that draws viewers in and can engage them in the issue and illustrate complex problems in ways that statistics cannot" (Barrett and Leddy, 6). Public Awareness. Film can increase public awareness by bringing light to issues and stories that may have otherwise been unknown or not often thought about. This is the level of impact that has received the most attention, as films are often discussed in terms of their "educational" value. "A project's ability to raise awareness around a particular issue, since awareness is a critical building block for both individual change and broader social change" (Barrett and Leddy, 6). Public Engagement. Impact, however, need not stop at simply raising public awareness. Engagement "indicates a shift from simply being aware of an issue to acting on this awareness. Were a film and its outreach campaign able to provide an answer to the question 'What can I do?' and more importantly mobilize that individual to act?" (Barrett and Leddy, 7). This is where an associated film campaign becomes increasingly important, as transmedia outlets such as Facebook, websites, blogs, etc. can build off the interest and awareness developed through watching a film and provide outlets for viewers channel their constructive efforts. Social Movement. In addition to impacts on individuals, films can also serve to mobilize groups focused on a particular problem. The filmmaker can create a campaign around the film to promote its goals and/or work with existing groups focused on a particular issue, so that the film can be used as a tool for mobilization and collaboration. "Moving beyond measures of impact as they relate to individual awareness and engagement, we look at the project's impact as it relates to the broader social movement … if a project can strengthen the work of key advocacy organizations that have strong commitment to the issues raised in the film" (Barrett and Leddy, 7). Social Change. The final level of impact and "ultimate goal" of an issue-based film is long-term and systemic social change. "While we understand that realizing social change is often a long and complex process, we do believe it is possible and that for some projects and issues there are key indicators of success" (Barrett and Leddy, 7). This can take the form of policy or legislative change, passed through film-based lobbying efforts, or shifts in public dialogue and behavior. Legislative change typically takes place beyond the social movement stage, when there is enough support to pressure legislators to change or create policy. Film-inspired activism has been seen in issues ranging from environmental causes such as agriculture (Food Inc.) and toxic products (Blue Vinyl) to social causes such as foreign conflict (Invisible Children) and education (Waiting for Superman). Documentary films can also have a strong influence as media agenda-setters, as films provide dramatic "news pegs" for journalists seeking to either sustain or generation new coverage of an issue (Nisbet "Introduction" 5), such as the media coverage of climate change in conjunction with An Inconvenient Truth. Barrett and Leddy, however, note that not all films target all five impacts and that different films may lead to different impacts. "In some cases we could look to key legislative or policy changes that were driven by, or at least supported by the project... In other cases, we can point to shifts in public dialogue and how issues are framed and discussed" (7). It is possible that specific film and/or campaign characteristics may lead to different impacts; this is a nascent area for research and one with great promise for both practical and theoretical utility. Innovations in Tools and Methods Finally, the selection of tools is a vital component for assessing impact and the new media landscape is enabling innovations in the methods and strategies for program evaluation. Whereas the traditional domain of film impact measurement included box office statistics, focus groups, and exit surveys, innovations in data collection and analysis have expanded the reach of what questions we can ask and how we are able to answer them. For example, press coverage can assist in understanding and measuring the increase in awareness about an issue post-release. Looking directly at web-traffic changes "enables the creation of an information-seeking curve that can define the parameters of a teachable moment" (Hart and Leiserowitz 360). Audience reception can be measured, not only via interviews and focus groups, but also through content and sentiment analysis of web content and online analytics. "Sophisticated analytics can substantially improve decision making, minimize risks, and unearth valuable insights that would otherwise remain hidden" (Manyika et al. 5). These new tools are significantly changing evaluation, expanding what we can learn about the social impacts of film through triangulation of self-report data with measurement of actual behavior in virtual environments. Conclusion The changing media landscape both allows and impels evaluation of film impacts on individual viewers and the broader culture in which they are imbedded. Although such analysis may have previously been limited to box office numbers, critics' reviews, and theater exit surveys, the rise of new media provides both the ability to connect filmmakers, activists, and viewers in new ways and the data in which to study the process. This capability, combined with significant growth in the documentary landscape, suggests a great potential for documentary film to contribute to some of our most pressing social and environmental needs. A social scientific approach, that combines empirical analysis with theory applied from basic science, ensures that impact can be measured and leveraged in a way that is useful for both filmmakers as well as funders. In the end, this attention to impact ensures a continued thriving marketplace for issue-based documentary films in our social landscape. References Abrash, Barbara. "Social Issue Documentary: The Evolution of Public Engagement." American University Center for Social Media 21 Apr. 2010. 26 Sep. 2011 ‹http://www.centerforsocialmedia.org/›. Aufderheide, Patricia. "The Changing Documentary Marketplace." Cineaste 30.3 (2005): 24-28. Barnouw, Eric. Documentary: A History of the Non-Fiction Film. New York: Oxford UP, 1993. Barrett, Diana and Sheila Leddy. 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