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Item Effect of alcohol consumption and tobacco smoking on psychological distress: a quasi-experimental study using the 2022 Kenya demographic health survey data(BMJ Group, 2025-06-16) Kamau, Kennedy; Andeso, Pauline; Muga, Winstoun; Karisa, Amani; Musyoki, Davis; Kuria, Joseph Mutura; Kadengye, Damazo T; Izudi, JonathanMethods: We analysed the 2022 Kenya Demographic Health Survey data. The primary exposure was alcohol consumption, and tobacco smoking was the secondary exposure. The outcome was psychological distress. We employed propensity score matching to achieve comparability on observed covariates between the exposed and unexposed groups. We then performed conditional logistic regression analysis, adjusting for matched pairs to establish a cause-effect relation between the exposures of interest and the outcome. We reported the OR and 95% CI. We conducted a sensitivity analysis using Mantel-Haenszel bounds to check for the robustness of the cause-effect findings to unmeasured confounders. Results: Of the 46 609 participants included in the study, 6450 (13.8%) consumed alcohol, while 2353 (5.0%) smoked tobacco. Overall, 1091 (2.3%) participants reported psychological distress. Among alcohol consumers, 352 (32.3%) reported psychological distress, compared with 115 (10.5%) among tobacco smokers. In a 1:1 ratio, we matched 10 070 individuals based on alcohol consumption and 4270 based on tobacco smoking status. In propensity-score-matched analysis, alcohol consumption (OR 2.76, 95% CI 2.06 to 3.70) and tobacco smoking (OR 2.04, 95% CI 1.29 to 3.24) showed an effect on psychological distress. Conclusion: This study found that alcohol consumption and tobacco smoking increase psychological distress among adults aged 15-54 years in Kenya. There is, therefore, a need to screen for psychological distress among people who drink alcohol or smoke tobacco to provide them with prompt mental health interventions.Item Initiation of breastfeeding among mothers attending a regional referral hospital in central Uganda: a cross-sectional study(Springer Nature, 2025-06-16) Nakayiza, Vivianne; Izudi, Jonathan; Nasuuna, Esther M; Atim, FionaBackground: Breastfeeding initiation within the first hour of birth is beneficial in reducing the risk of maternal and neonatal mortality. However, a significant proportion of mothers delay initiating breastfeeding within an hour of birth, but the association with age has not been rigorously studied. We examined the association between maternal age and delayed initiation of breastfeeding in a large urban referral hospital in central Uganda. Methods: This analytic cross-sectional study was conducted at the Entebbe Regional Referral Hospital in Central Uganda. Data were collected using a researcher-administered questionnaire between October 1, 2019, and December 20, 2019. Delayed initiation of breastfeeding was the primary outcome, defined as putting the newborn to the breast after one hour of birth. The primary exposure was maternal age categorized as 15–24, 25–34, and 35–45 years. We performed a modified Poisson regression analysis to determine the independent association between maternal age and delayed initiation of breastfeeding, adjusting for other confounders. We stated the findings as an adjusted prevalence ratio (aPR) and 95% confidence interval (CI). Results: We studied 384 participants with a mean age of 27.5 ± 5.5 years. Of the 384 participants studied, 275 (71.6%) had delayed initiating breastfeeding, with the majority aged 15–24 years. In a multivariable analysis, delayed initiation of breastfeeding was significantly associated with maternal age groups of 15–24 years (aPR 1.28, 95% CI 1.01,1.63) and 25–34 years (aPR 1.28, 95% CI 1.01–1.60) compared to the reference group of 35–45 years. Additionally, delivery through cesarean section compared to spontaneous vaginal delivery was associated with delayed initiation of breastfeeding (aPR 1.93, 95% CI 1.49–2.49). Conclusion: Delayed initiation of breastfeeding is common and is associated with maternal age (15–24 and 25–34 years) as well as delivery through cesarean section. Routine health education and staff mentoring are needed to enhance early initiation of breastfeeding to prevent maternal and neonatal morbidity and mortality.Item Return to care of children and adolescents living with HIV who missed their clinic visits or were lost to follow-up: a continuous quality improvement study in Uganda(Springer Nature, 2025-06-13) Ssentongo, Mugerwa Saadick; Izudi, Jonathan; Oryokot, Boniface; Opito, Ronald; Bakashaba, Baker; Munina, Abel; Opolot, Kokas; Ogwal, Daniel; Ssendiwala, Julius; Mugisha, KennethBackground: While the UNAIDS 95-95-95 targets have been met among adults, those for children and adolescents remain suboptimal. This study aimed to improve the return-to-care rates among children and adolescents living with HIV (CALHIV) who missed clinic appointments at a county-level rural health facility in eastern Uganda. Methods: Between January 2023 and January 2024, we conducted a continuous quality improvement (CQI) study. A CQI committee was established through entry meetings and training, and quality of care gaps were identified through data reviews. We prioritised one gap for CQI through ranking, performed a root-cause analysis using a fishbone diagram, and developed and ranked improvement changes using the impact-effort matrix. The improvement changes were implemented using Plan-Do-Study-Act cycles. The changes included (1) line listing CALHIV with missed appointments and following up via phone calls; (2) weekly data reviews to harmonise missed appointments and (3) assigning community health workers (CHWs) to trace and return CALHIV to care. We tracked and plotted the proportion of CALHIV returning to care over time to assess improvements. Results: Before the implementation of CQI initiatives (August 2022-January 2023), the average return-to-care rate was 35% (baseline). Following the initiation of CQI in February 2023, the average return-to-care rate increased to 59% from February to May 2023 with the introduction of line listing (phase 1), to 69% from June to September 2023 with the implementation of weekly data reviews (phase 2), and to 88% from October 2023 to January 2024 with the involvement of CHWs (phase 3), ultimately reaching a peak of 100% in January 2024. Conclusion: The CQI approach improved the return to care of CALHIV who missed clinic appointments, allowing access to optimal care and better health outcomes. These findings should serve as preliminary data for larger randomised studies.Item Strengthening the resilience and sustainability of Uganda’s coffee sector: investigating governance mechanisms in coffee innovation platforms(International Journal of Agricultural Extension, 2025-03-14) Ochago, RobertEffective governance mechanisms for coffee innovation platforms are crucial to fostering resilience and sustainability in Uganda’s vital sector. Despite extensive research on the governance of innovation platforms, a clear and unified definition of innovation platform governance mechanisms remains elusive. This lack leads to inconsistencies in interpreting and implementing innovation platform governance mechanisms, obstructing efforts to tackle critical challenges in the coffee sector. This study examines the governance mechanisms of coffee innovation platforms in Uganda, which serve as collaborative networks for stakeholders throughout the coffee value chain. Coffee innovation platforms play a crucial role in addressing sector-specific challenges by facilitating knowledge exchange, encouraging stakeholder engagement, and promoting the co-creation of solutions. Data from 91 farmers (54 males, 37 females) on the coffee innovation platform were collected using qualitative methods, specifically focus group discussions and individual interviews. Thematic analysis generated overarching themes for governance structures, processes, and principles. The study reveals that innovation platform governance structures encompass a diverse range of stakeholders, facilitators, interaction spaces, and frameworks. The innovation platform processes include stakeholder engagement, knowledge sharing, and capacity building. The fundamental principles of these platforms are participation, partnerships, and collaborative knowledge sharing. This research yields actionable insights for agricultural extension policymakers, leaders of coffee innovation platforms, and extension workers to enhance the governance of coffee innovation platforms.Item How innovation platforms govern the experiential learning process of coffee farmers in Uganda(African Journals Online, 2024-12-16) Ochago, RobertWhile researchers, development actors, and policymakers recognize that Innovation Platforms govern farmers' development knowledge when attempting to address challenges, the question of how IPs’ governance mechanisms affect their learning process remains unaddressed. Using data from a cross-sectional survey of 214 coffee IP farmers, this study employs Partial Least Squares-Structural Equation Modeling (PLS-SEM) to analyze the relationships between IP governance and farmers’ experiential learning. The relationship between challenges, reflection, experiential knowledge, active experimentation, and IP governance mechanisms (that is, IP members' commitment and trust, IP members' involvement, and Member access to IP resources) was specifically examined. Results show that when farmers try to address their challenges, IP governance mechanisms positively and negatively affect their acquisition of experiential knowledge through reflection and active experimentation using existing knowledge. Specifically, Innovation Platform members' commitment, trust, and involvement significantly and positively moderate the link between farmers’ challenges and their reflection, while the influence of members' access to IP resources is insignificant. Similarly, while access to IP resources has an insignificant and negative moderation effect on the link between farmers’ reflection and experiential knowledge, IP members' commitment, trust, and involvement have positive but insignificant effects on them. Farmers' commitment, trust, involvement, and access to IP resources did not affect the relationship between their experimentation and experiential knowledge. Finally, the IP members' commitment, trust, involvement, and access to IP resources have insignificant effects on the relationship between farmers’ active experimentation and their challenges. Coffee farmers should use their networks to encourage commitment and involvement in intellectual property to reflect and gain knowledge. Similarly, IP facilitators should build trust among their members. Agriculture extension policymakers can use IPs as units to identify practical interventions to local challenges and improve targeted rural agriculture value chains by connecting different stakeholders to farmers at the community level because reflection as a learning activity must be consciously elicited through learning actions.Item What does the reflective learning of Ugandan coffee farmers mean for agricultural extension and advisory services?(EScience Press, 2024-08-23) Ochago, RobertWhereas reflection is essential for learners to make sense of their challenging experiences, little is known about how farmers reflect on their challenging experiences in agricultural practices. This study explores how farmers reflect on their challenges in coffee value chain practices. Using qualitative methods, including focus group discussions and individual interviews with 91 coffee IP farmers from diverse backgrounds, the study identified various challenges—pests and diseases, low and poor coffee quality, and untrustworthy and unreliable coffee buyers—that impact their livelihoods and production. Findings reveal that farmers' reflection varies in frequency and depth, with many engaging in informal discussions with fellow farmers in their communities and a smaller number using individual reflective methods. The research highlights that people who actively engage in reflective practices make more informed decisions, resulting in adaptive methods that improve resilience and sustainability in their farming operations. The study stresses the need to create an atmosphere that promotes structured reflection and peer-to-peer sharing, which will lead to better agricultural practices and outcomes in coffee sector.Item The effect of Ugandan coffee farmers’ role identity on their experiential learning(Sage, 2024-04-07) Ochago, Robert; Dentoni, Domenico; Mahdad, MaralBackground: Although the literature on education and learning sciences determined how student identities influence their experiential learning process, this link is less clear in the agricultural context, where farmers have faced unique value chain challenges i.e., production to marketing. Purpose: This study contributes to examining how farmers’ role identities support or hamper farmers’ experiential learning processes. Methodology: First, a qualitative analysis of 91 interviews with coffee farmers in Uganda was carried out to understand the nature and relevance of farmers’ role identities. Second, using partial least squares regression-based path analysis, the moderating effect of 214 coffee farmers’ production role identity on their experiential learning was assessed. Findings: Findings reveal that farmers’ identification as coffee farmers shape what, how, and when they learn from their value chain challenges. Farmers’ role identity, in particular, supports their reflection on past challenges to increase their challenge-solving knowledge, as well as experimentation to solve their challenges. Implications: This study integrates role identity theories in the study of learning processes in rural coffee value chains. Moreover, the findings suggest that agricultural extension workers should understand farmers’ identities and their influence on their learning to select the targets and developments of their training programs.Item Pioneering the use of embedded research translation methodology for potential increased income and livelihoods of smallholder farmers(2025-02-26) Kajobe, Robert; Kabuga, Experito Muyanja; Dricile, Ratib; Wadri, Victor; Malingumu, Richard; Yumbya, PeninahWhereas participatory research and development is widely acclaimed, an effective explicit procedure for ensuring end-user participation remains a holy grail. Our study proposes a simple participatory approach by operationalizing the Embedded Research Translation (ERT), developed by LASER PULSE, and demonstrates its application among smallholder vegetable farming communities in the West Nile sub-region of Uganda. The ERT involves integrating research findings directly into practical applications or solutions within specific contexts. It emphasizes collaboration between researchers and stakeholders, ensuring that findings are relevant, actionable, and effectively applied in real-world scenarios. It is built on four pillars: (i) partnerships between researchers and stakeholders (ii) engaging in a process of generating a relevant research (iii) product and (iv) dissemination of findings. Based on these pillars and their underlying principles, an implementation process is recommended, beginning with a start-up stage where researchers actively involve a diverse range of partners and stakeholders. This is followed by a design stage, characterized by participatory discussions, collaborative decision-making, and planning. These steps guide the implementation phase, during which partners remain actively engaged in research. Finally, the partnership collectively disseminates the findings to maximize impact and uptake. In our study, we adapted the method to Ugandan context using a five-stage procedure: In the first stage (understanding the context), researchers rapidly obtain as much information as possible about the relevant aspects of the target cropping system and the broad areas of intervention through literature review, and quantitative baseline surveys. This is followed by the second stage (co validation) in which the information is validated by stakeholders through FGDs and feedback meetings. At the third stage (co-selection of priority areas of interventions), researchers and stakeholders co-select target crops and specific constraints to be addressed. The fourth stage is co-development which involves co-ideation and co-testing of potential technologies. The final stage (dissemination) consists of scaling the co-developed technologies through the partnership and other dissemination channels.Item Providing targeted incentives for trees on farms: A transdisciplinary research methodology applied in Uganda and Peru(Elsevier, 2023-03-11) Rode, Julian; Escobar, Marcela Muñoz; Khan, Sabina J.; Borasino, Elena; Kihumuro, Phillip; Okia, Clement Akias; Robiglio, Valentina; Zinngrebe, YvesNative trees are central elements of sustainable agriculture, providing economic futures to rural populations while safeguarding biodiversity and ecosystem services. We present a diagnostic methodology for (i) identifying ‘incentive opportunities’ for farmers to plant and manage trees on farms; (ii) proposing targeted packages of incentive and finance instruments; and (iii) describing levers for policy integration to support their implementation. In two case studies from Uganda and Peru, the ‘incentive opportunities’ consist of providing technical and financial support to farmers for planting and managing trees, generating income sources from native trees and support from the beneficiaries of tree-based ecosystem services, and eliminating incentives for tree removal. Many instruments to promote trees on farms already exist, but implementation is hampered by weak and fragmented institutions, limited funding and low political priority. The proposed methodology can guide the development of incentive instruments as part of implementing policy strategies for integrated biodiversity conservation and sustainable development.Item A healthy diet for a growing population: a case study of Arua, Uganda(Springer Nature, 2023-01-27) Hermelink, Marleen I.; Pittore, Katherine H.; Álvarez Aranguiz, Adolfo; Pereira da Silva, Fatima I.; Roefs, Marlene M. I.; Kajobe, Robert; Malingumu, Richard; Hengsdijk, HuibIt is uncertain whether Sustainable Development Goal 2 (SDG2), a healthy diet for all, can be achieved in East Africa given its strong population growth, low agricultural yields, and the high perishability of nutrient-dense foods. We examine the consequences of a locally produced healthy diet on land use in a case study of the Arua district in Uganda. This type of analysis can alert policy makers to looming nutrition gaps and support the selection of alternative solution strategies. Using a linear programming (LP) model and three population growth projections, we estimate the minimum agricultural area needed in 2040 to produce a healthy diet that follows EAT-Lancet dietary diversity guidelines and supplies the average requirements of calories, proteins, Iron, and vitamin A. We also compare in scenarios to what extent i) production intensification, ii) food loss reduction, iii) by-product consumption, and iv) vitamin supplementation could reduce the required agricultural area. Results show that the necessary area to produce a healthy diet in 2040 is 160% larger than Arua’s current crop area and would greatly exceed the district’s total area. We also show that none of the changes proposed in our scenarios allows a sufficient increase in food production, suggesting that a mix of even more drastic changes across sectors will be necessary. The results underline the challenge for rural areas in East Africa like Arua to provide a healthy diet to its fast growing population, requiring integrated food system changes and policy coordination to orchestrate the increased availability of diverse and nutritious foods.Item Kernel morphometric characteristics and oil content among Shea tree genotypes in Uganda(African Journals Online, 2022-09-23) Odoi, J. B; Okia, Clement Akias; Gwali, S.; Odong, T. L.; Agaba, H.; Okullo, J. B. L.Shea tree (Vitellaria paradoxa subsp. nilotica) is an important commercial tree for domestic oil and industrial products of cosmetics, chocolate and other confectionaries traded grown worldwide. We studied seed morphometric characteristics and crude oil content of Shea nuts in Uganda. Five populations, comprising of 16 ethnovarieties, were selected from Eastern, Northern and West Nile Sub-regions of Uganda, based on their attributes as judged by the farmers. Fresh kernel weight ranged from 2 to 18.85 mg per seed. Kernel weight increased with Shea fruit weight (y = 0.1499x + 6.1887, R² = 0.306). Moyo district had the highest oil content (54.37 ± 0.32%); while Amuru district had the lowest oil content (50.5 ± 1.32%). Oil content decreased with increasing kernel size (y = -0.4541x + 57.303, R² = 0.2116) and dry matter content (y = 0.635x - 9.863, R²= 0.011); and varied between ethnovarieties and Shea tree populations, p = 0.003 and P< 0.001, respectively. Tinny seeded (45.7 - 65.49%), Round fruited (45.41 - 65.91%), Dwarf tree (45.19 - 64.19%), Elliptical fruited (45.32 - 64.19%) and Soft pulped (42.16 - 69.77%) ethnovarieties had the highest oil content. Narrow sense heritability (h2) for oil yield was 1.72; while response to selection (R) was 16.48 with genetic gain (Gs) of 2.21%, given 10% top selection intensity.