Muni Repository (MR)
This repository contains open access publications of Muni University Library.
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Recent Submissions
Innovation platforms and value chain role expansion among Ugandan coffee farmers: Evidence on peer learning, group option, and legitimacy
(EScience Press, 2026-02-25) Ochago, Robert
Innovation platforms can help Ugandan coffee smallholders expand their roles in the value chain, beyond production, when they create repeated peer learning, support group action, and build legitimacy for new roles. However, most research emphasises platform design and average outcomes and says little about the daily social costs of upgrading attempts, such as recognition, trust, moral pressure, and jealousy. This study examines how smallholders in eastern Uganda identify value chain constraints, what they learn through platform participation, and how local legitimacy shapes who persists as trader, mobiliser, or processor. Qualitative methods were used, including focus group discussions and interviews of 91 innovation platform participants from Kapchorwa, Manafwa, and Namisindwa districts. The study applied a reflective thematic analysis. The study found that the expansion of the roles beyond primary production, including marketing, buying, coordination, and service, is achieved through practical learning, peer learning, training and interactions. The dynamics of recognition by others enhance farmers' trust, enabling them to sustain these expanded roles. On the other hand, recognition also creates new obligations and moral pressure, with expectations for support, training others, and exemplary behaviour, which sometimes contribute to conflict and to withdrawal from leadership or facilitation roles. As much as collective action spaces created opportunities for bargaining and visibility, they also generated tensions over governance and the sharing of benefits. This study contributes to extension research by illustrating how platforms contribute to value chain upgrading through socially verified learning and legitimacy, and by creating social costs for the longevity of new farmer roles. The policy implications point to the need to design innovation platforms that consider governance, equitable recognition and opportunities, and support for farmer intermediaries.
Viral load suppression after intensive adherence counselling among previously non-suppressed adolescents and young people with HIV in East-Central Uganda
(Taylor & Francis, 2026-03-03) Ejalu, David Livingstone; Okello, Peter Simon; Puleh, Sean Steven; Nangendo, Joanita; Izudi, Jonathan; Bakeera-Kitaka, Sabrina; Katamba, Achilles; Katahoire, Anne R; Kalyango, Joan N; Cattamanchi, Adithya; Semitala, Fred C; Kamya, Moses R
Background: Viral load suppression remains suboptimal among adolescents and young people living with HIV in Uganda (AYPLHIV). Although Intensive Adherence Counselling is recommended for individuals who remain virally non-suppressed while on antiretroviral therapy, its contribution to suppression among AYPLHIV is not well understood. This study aimed to determine the level of viral load suppression achieved following intensive adherence counselling among previously non-suppressed AYPLHIV in east central Uganda.
Methods: We conducted a sequential explanatory mixed methods study among 580 participants aged 10– 24 years receiving care at 32 health facilities. Quantitative data were abstracted covering a five-year period from 2019– 2024. Suppression levels and subgroup differences were assessed using chi-square tests. A qualitative study was conducted with 12 purposively selected participants and thematic analysis were guided by the Capability, Opportunity, Motivation and Behavior framework.
Results: Participants had a median age of 16.4 years and a median ART duration of 4 years. Overall, out of the 580 participants, 313 (53.9%) achieved viral load suppression after counselling. Participants living more than 5 km compared to less than 5km from a health facility (p=0.003) and those counselled by counsellors rather than nurses (p< 0.001) had significantly higher suppression level. Lower suppression level was observed among participants who had not disclosed their HIV status versus those who disclosed (p=0.011) and those reporting fear or stigma compared to those not reporting (p=0.010). Qualitative findings indicated that understanding the purpose and benefits of intensive adherence counselling (Capability), financial barriers and provider interactions (Opportunity), and non-disclosure (Motivation) influenced suppression outcomes among AYPLHIV.
Conclusion: IAC resulted in modest improvements in VL suppression among AYPLHIV. Low retention and contextual barriers, including distance, stigma and non-disclosure, limited its effectiveness. Tailored IAC strategies addressing subgroup-specific barriers are needed to improve VL suppression.
Effectiveness of ART optimization on viral load suppression in children and adolescents with HIV in Uganda: A quasi-experimental study
(Wolters Kluwer Health, 2026-02-27) Nasuuna, Esther M; Babirye, Lillian; Kigozi, Joanita; Muganzi, Alex; Izudi, Jonathan
Uganda implemented the antiretroviral therapy (ART) optimization program in July 2019, based on an eligibility rule. ART optimization targeted individuals with prior viral load (VL) < 1000 copies/mL, while those with VL ≥ 1000 copies/mL continued with non-optimized regimens. We assessed the effectiveness of ART optimization on VL suppression among children and adolescents with HIV (CAWH) in Uganda. We also assessed the compliance of human immunodeficiency virus (HIV) clinics with the eligibility rule and its effect on ART optimization. Therefore, we designed a quasi-experimental study using data from 21 urban and rural HIV clinics. The exposure was ART optimization, defined as the initiation or transition of CAWH on dolutegravir or a protease inhibitor (boosted lopinavir). Children and adolescents with HIV on an optimized ART regimen formed the exposed group, while those on a non-optimized ART regimen comprised the nonexposed group. The primary outcome was VL suppression, defined by VL < 1000 copies/mL after ≥6 months of ART optimization. We assessed the effectiveness of ART optimization on VL suppression using 2-stage least squares instrumental variable regression due to imperfect compliance with the eligibility rule across the clinics. We also established the effectiveness of the eligibility rule on ART optimization for individuals just below and just above the cutoff. Sensitivity analysis was performed using a noncausal approach. We analyzed data from 2999 CAWH aged ≤19 years and found an overall VL suppression of 76.1% (2282/2999). We found that ART optimization showed a trend toward improved VL suppression (risk ratio [RR] 1.81, 95% CI: 0.79–4.14). However, compliance with the rule was only for 2.6% of the participants, and the rule did not improve ART optimization (RR 0.96, 95% CI: 0.88–1.05). Overall, ART optimization, guided by an eligibility rule, did not achieve the target of ≥95% VL suppression among CAWH across the 21 public HIV clinics in Uganda, partly due to low compliance with the rule, although it showed a trend toward improvement. Addressing context-specific biological, behavioral, social, and structural barriers is needed to optimize VL outcomes.
Magnitude and correlates of overweight or obesity among adults with diabetes mellitus duration of five or more years in rural Uganda: A cross-sectional study
(Elsevier, 2026-02-26) Lumori, Boniface Amanee Elias; Lodiong, Lodiong Jackson Dumo; Ucama, Ufoymungu Patrick; Izudi, Jonathan
Background
Overweight and obesity are major risk factors for micro and macrovascular diseases, with diabetes mellitus exacerbating these burdens. We determined the prevalence of overweight or obesity and its associated factors among adults with diabetes mellitus with a duration of ≥5 years at Mbarara Regional Referral Hospital in Southwestern Uganda.
Methods
This analytic cross-sectional study was conducted over 5 months, from November 2017 to March 2018. We collected demographic and clinical data and measured body mass index (BMI). The outcome was overweight or obesity, measured as the proportion of individuals with a BMI of 25 kg/m2 or more. We used binary logistic regression to estimate associations of a priori selected variables with the outcome.
Results
Of 189 participants, 138 (73%) were female, the mean age was 61.5 ± 11.1 years, and the median duration of diabetes mellitus since diagnosis was 10 years (interquartile range, 7–15). Overall, 122 (64.5%) participants were overweight or obese. In the multivariable logistic regression analysis, former cigarette smoking (adjusted odds ratio (AOR) 0.2, 95% confidence interval (CI) 0.1–0.6), every 1-year increase in the duration of diabetes mellitus (AOR 1.1, 95% CI 1.0–1.1), and hypertension (AOR 2.8, 95% CI 1.2–6.5) were independently associated with overweight or obesity.
Conclusion
Overweight/obesity is prevalent among adults with diabetes mellitus duration of 5 years and over, in a rural Ugandan population. Former cigarette smokers have a decreased likelihood of being overweight or obese, while hypertension and every 1-year increase in the duration of diabetes mellitus are associated with a higher likelihood of being overweight or obese.
Participation of livestock farmers and community animal health workers in one health intervention to control zoonotic diseases in Rwanda: a qualitative study
(Springer Nature, 2026-01-27) Hugor, Shema; Izudi, Jonathan; Shyaka, Anselme
Background
In zoonotic disease hotspots, engaging local communities in zoonotic disease monitoring and reporting is essential for effective prevention and early outbreak detection. In Rwanda, the Eastern Province has experienced nearly 90% of all zoonotic disease outbreaks. This qualitative study explored the participation of livestock farmers and community animal health workers (CAHWs) in One Health interventions aimed at controlling zoonotic disease outbreaks in Nyagatare district, Eastern Province, Rwanda.
Method
Among livestock farmers and CAHWs, we collected qualitative data through in-depth interviews and focused group discussions. We held key informant interviews with district-level officials, namely district veterinary, district health, and district environmental health officers, to validate the data from livestock farmers and CAHWs. The data were transcribed verbatim and verified by replaying the audio recordings. Content analysis was performed.
Results
Five major themes emerged as areas of participation: (i) capacity building focused on livestock management and livestock disease identification and prevention; (ii) community-level health education encompassing zoonotic disease risk communication and awareness raising; (iii) interruption of zoonotic disease transmission that comprised infection prevention and control, separation of sick and healthy livestock, quarantine, and zero grazing, adherence to guidelines, and the testing, treatment, spraying, and vaccination of livestock; (iv) collaboration with multiple sectors via training on zoonotic diseases, including its treatment, investigation, and prevention; and 5) zoonotic disease surveillance that included livestock monitoring and inspection for zoonotic diseases and the notification and reporting of zoonotic diseases to relevant authorities. The collaboration between the environmental health sector and the animal and human sectors was weak, while vaccination targeted mainly cattle but not small ruminants.
Conclusions
Livestock farmers and CAHWs participate in several One Health interventions aimed at controlling zoonotic diseases, particularly in vaccination campaigns for cattle, community sensitization, and basic animal husbandry practices. However, collaboration between the environmental health sector and the animal and human sectors was weak, vaccination efforts largely excluded small ruminants, and some farmers relied on local herbs for treatment due to limited access to professional veterinary services. Efforts to sustain the major areas of participation are needed, while weaker areas need strengthening.