Gender is often neglected in health systems, yet health systems are not gender neutral. Within health systems research, gender analysis seeks to understand how gender power relations create inequities in access to resources, the distribution of labour and roles, social norms and values, and decision-making. This paper synthesises findings from nine studies focusing on four health systems domains, namely human resources, service delivery, governance and financing. It provides examples of how a gendered and/or intersectional gender approach can be applied by researchers in a range of low- and middle-income settings (Cambodia, Zimbabwe, Uganda, India, China, Nigeria and Tanzania) to issues across the health system and demonstrates that these types of analysis can uncover new and novel ways of viewing seemingly intractable problems. The research used a combination of mixed, quantitative, qualitative and participatory methods, demonstrating the applicability of diverse research methods for gender and intersectional analysis. Within each study, the researchers adapted and applied a variety of gender and intersectional tools to assist with data collection and analysis, including different gender frameworks. Some researchers used participatory tools, such as photovoice and life histories, to prompt deeper and more personal reflections on gender norms from respondents, whereas others used conventional qualitative methods (in-depth interviews, focus group discussion). Findings from across the studies were reviewed and key themes were extracted and summarised. Five core themes that cut across the different projects were identified and are reported in this paper as follows: the intersection of gender with other social stratifiers; the importance of male involvement; the influence of gendered social norms on health system structures and processes; reliance on (often female) unpaid carers within the health system; and the role of gender within policy and practice. These themes indicate the relevance of and need for gender analysis within health systems research. The implications of the diverse examples of gender and health systems research highlighted indicate that policy-makers, health practitioners and others interested in enhancing health system research and delivery have solid grounds to advance their enquiry and that one-size-fits-all heath interventions that ignore gender and intersectionality dimensions require caution. It is essential that we build upon these insights in our efforts and commitment to move towards greater equity both locally and globally.

This study assessed concentrations of pesticide residues in fruits and vegetables from farm-to-fork in Kampala Metropolitan Area, Uganda. A total of 160 samples of fruit and vegetables collected from farms, markets, streets, restaurants and homes were analysed using liquid chromatography–tandem mass spectrometry; and Gas Chromatograph–Mass Spectrometer for dithiocarbamates. Multiple pesticide residues were detected in majority of the samples (95.6%). The proportions of the most frequently detected pesticides residue classes were organophosphates (91.3%), carbamates (67.5%), pyrethroids (60.0%) dithiocarbamates (48.1%) and neonicotinoids (42.5%). Among organophosphates, propotamophos, acephate, fonofos, monocrotophos and dichlorvos were the most detected active ingredients; aminocarb, methomyl and pirimicarb were the commonly detected carbamates; while imidacloprid, a neonicotinoid and lambda-cyhalothrin, pyrethroid were also highly detected. Twenty-seven pesticide were tested at all stages, of which the concentrations either decreased or increased along the chain. Multiple pesticide residues occurred in commonly consumed fruit and vegetables with decreasing or increasing concentrations from farm-to-fork.

INTRODUCTION: tungiasis is an endemic but neglected health problem in Uganda especially in resource poor communities. It is largely affecting rural communities in the Eastern, West Nile and Central regions. This study assessed prevalence and risk factors associated with tungiasis in Mayuge district, Eastern Uganda.

Background. Only a third of the total waste generated in slum communities in Kampala is collected and disposed of to the landfill every month. This study assessed the status of household solid waste management and associated factors in a slum community in Kampala, Uganda. Methods. We conducted a community-based cross-sectional study involving 395 households using a semistructured questionnaire and an observational checklist. Proper solid waste management was determined based on possession of waste collection and storage receptacle; collection receptacle ability to minimise nuisances (covered); segregation of waste; presence of flies and other vectors; and collection receptacle fill status. Prevalence rate ratios and their 95% confidence intervals were used as a measure of association. Results. Only, 41.3% (163/395) of the households exhibited proper waste management practices. The majority of the households 85.8% (339/395) owned solid waste storage receptacles, most of which were sacs 61.7% (209/339) and would minimise nuisances 72.9% (245/339). The main type of waste collected was biodegradable materials 56.7% (224/395). The majority of the households 78.7% (311/395) did not segregate their waste. Solid waste was mainly transported to the collection point by pulling the collecting sac 54.4% (215/395). The city authority 73.9% (292/395) and private companies 12.9% (51/395) were the major entities collecting waste. Factors associated with proper waste management were collecting waste in plastic containers (adjusted PR = 1.27, 95% CI (1.04–1.55)), polythene bags (adjusted PR = 0.26, 95% CI (0.14–0.47)), and paper bags or metallic bins (adjusted PR = 0.13, 95% CI (0.03–0.44)) as well as awareness of solid waste management laws (adjusted PR = 1.49, 95% CI (1.20–1.85)) and the dangers of improper solid waste management (adjusted PR = 2.15, 95% CI (1.51–3.06)). Conclusion. Solid waste management was generally poor. As such, a cascade of interventions that address knowledge, physical, and behavioural aspects of solid waste management is required to improve its management in slum communities.

More than half of the disease burden in Uganda can be prevented through improving water, sanitation, and hygiene (WASH). In slum communities, water supply is insufficient but also highly contaminated; therefore, ensuring that the safe water chain is maintained by households is paramount to preventing water-related diseases. This study aimed at assessing knowledge and practices of households on safe water chain maintenance in slum communities in Kampala City, Uganda. This was a community-based cross-sectional study carried out among 395 households in slum communities in Kampala, Uganda. Data were collected using a semi-structured questionnaire. Prevalence ratios (PRs) and their 95% confidence intervals were used as a measure of association between safe water chain management and associated knowledge and practice factors. The PRs were obtained using a multivariable modified Poisson regression with logarithm as the link function, with robust standard errors. Majority (76.7%, 303/395) of the households collected their water from a piped water system and paid for the water (72.9%, 288/395). Almost all (97.2%, 384/395) of the participants said that they knew the dangers associated with drinking unsafe water, boiled their drinking water (95.4%, 377/395), and used storage containers that minimize contamination (97.0%, 383/395). However, only (32.4%, 128/395) of the households satisfactorily maintained the safe water chain. Female- (adjusted PR = 1.82, 95% CI (1.19–2.78)) and student-led households (adjusted PR = 1.58, 95% CI (1.03–2.41)) and those whose heads had attained post-primary education (adjusted PR = 1.48, 95% CI (1.02–2.17)) were more likely to satisfactorily maintain the safe water chain. This was similar among members who thought most contamination occurs during storage (adjusted PR = 1.47, 95% CI (1.10–1.97)). Only a third of the households maintained the safe water chain satisfactory. Female-led, student-led, and post-primary educated-led household and household that thought most contamination occurs during storage were more likely to maintain the safe water chain. There is a need to improve the level of awareness about the importance of the safe water chain among slum dwellers.

Objective: The objective of the project was to strengthen the community health worker (CHW) programme in Ssisa sub-county, Wakiso district, Uganda by providing a coherent, structured and standardized training, supervision and motivation package so as to enhance their performance. Results: The project trained all 301 CHWs who received non-financial incentives of t-shirts, gumboots and umbrellas, and 75 of them received solar equipment to support lighting their houses and charging phones. Twenty-four of the CHWs who had coordination roles received additional training. Three motorcycles were also provided to enhance transportation of CHW coordinators during their work including supervision. By end of the project, the CHWs had conducted 40,213 household visits, carried out health education sessions with 127,011 community members, and treated 19,387 children under 5 years of age. From the project evaluation, which used both quantitative and qualitative methods, 98% of the CHWs reported having improved competence in performance of their roles. In addition, the CHWs were highly motivated to do their work. The motorcycles were instrumental in supporting the work of CHW coordinators including monthly collection of reports and distribution of medicines. The project demonstrated that by improving training, supervision and motivation, performance of CHW programmes can be enhanced.