Uganda Martyrs University (UMU)

Profiling eco-environmentally vulnerable (EV) areas can contributeto the development of mechanisms for environmental protectionand sustainable management of ecological resources. Land coverchange, population density, annual precipitation, mean tempera-ture, remotely sensed indices, actual evapotranspiration, land sur-face temperature (LST), and runoff for the catchment for 1990, 2000,2011, and 2020 were used to assess spatiotemporal ecological vul-nerability. Spatial principal component analysis (SPCA) was used toassess thematic vulnerability for each year. The analytical hierarch-ical process (AHP) was then used to determine the weighting of thethematic maps to produce the final ecological vulnerability maps.Our results showed that most of the sub-basin had low and moder-ate vulnerability in 1990, 2000, 2011, and 2020, with the combinedproportion of these areas being 80.6%, 55.45%, 83.92%, and 85.1%,respectively. The areas classified as high vulnerability decreasedsteadily over the investigated years, except in 2000, where anincrease was observed. Most areas in the southern parts of the sub-basin were classified as moderately vulnerable, while high vulner-ability values were recorded in the northern areas. The southernparts of the Upper Mzingwane basin are drier and less populatedthan the northern parts. The spatial architecture of vulnerability pre-sented will help inform decision makers in mitigation planning andoverall disaster risk management initiatives in the basin.

The achievement of several Sustainable Development Goals (SDGs) and the Paris Climate Agreement depends on rapid progress towards sustainable food and land systems in all countries. We have built a flexible, collaborative modeling framework to foster the development of national pathways by local research teams and their integration up to global scale. Local researchers independently customize national models to explore mid-century pathways of the food and land use system transformation in collaboration with stakeholders. An online platform connects the national models, iteratively balances global exports and imports, and aggregates results to the global level. Our results show that actions toward greater sustainability in countries could sum up to 1 Mha net forest gain per year, 950 Mha net gain in the land where natural processes predominate, and an increased CO2 sink of 3.7 GtCO2e yr-1 over the period 2020-2050 compared to current trends, while average food consumption per capita remains above the adequate food requirements in all countries. We show examples of how the global linkage impacts national results and how different assumptions in national pathways impact global results. This modeling setup acknowledges the broad heterogeneity of socio-ecological contexts and the fact that people who live in these different contexts should be empowered to design the future they want. But it also demonstrates to local decision-makers the interconnectedness of our food and land use system and the urgent need for more collaboration to converge local and global priorities.

Background Diabetic foot ulcer (DFU) is a devastating complication of diabetes mellitus (DM) that is associated with increased mortality, morbidity, amputation rate and economic burden. This study aimed at identifying the anatomical distribution and factors associated with severity of DFU in Uganda. Methodology This was a multicenter cross-sectional study conducted in seven selected referral hospitals in Uganda. A total of 117 patients with DFU were enrolled in this study between November 2021 and January 2022. Descriptive analysis and modified Poisson regression analysis were performed at 95% confidence interval; factors with p-value < 0.2 at bivariate analysis were considered for multivariate analysis. Results The right foot was affected in 47.9% (n = 56) of patients, 44.4% (n = 52) had the DFU on the plantar region of the foot and 47.9% (n = 56) had an ulcer of > 5 cm in diameter. The majority (50.4%, n = 59) of patients had one ulcer. 59.8% (n = 69) had severe DFU, 61.5% (n = 72) were female and 76.9% had uncontrolled blood sugar. The mean age in years was 57.5 (standard deviation 15.2 years). Primary (p = 0.011) and secondary (p < 0.001) school educational levels, moderate (p = 0.003) and severe visual loss (p = 0.011), 2 ulcers on one foot (p = 0.011), and eating vegetables regularly were protective against developing severe DFU (p = 0.03). Severity of DFU was 3.4 and 2.7 times more prevalent in patients with mild and moderate neuropathies (p < 0.01), respectively. Also, severity was 1.5 and 2.5 higher in patients with DFU of 5–10 cm (p = 0.047) and in those with > 10 cm diameter (p = 0.002), respectively. Conclusion Most DFU were located on the right foot and on the plantar region of the foot. The anatomical location was not associated with DFU severity. Neuropathies and ulcers of > 5 cm diameter were associated with severe DFU but primary and secondary school education level and eating vegetables were protective. Early management of the precipitating factors is important to reduce the burden of DFU.

: Early sexual debut is defined as having had first sexual intercourse at or before age 14 years of age. By 19 years, nearly 70% of both males and females are reported to have ever had sexual intercourse. Notably, sexual debut occurring at an earlier age than 19 years, especially less than 15 years, is found to be associated with engagement in risky sexual behaviours in adolescence. The objective of this study was to determine the factors associated with early sexual debut among adolescents in Kasawo Sub-county, Mukono district. Analytical cross-sectional study design, both qualitative and quantitative methods, was used. Focus group discussion guide and semi-structured questionnaire were administered to a sample of 385 adolescents. Statistical Package for Social Scientists (SPSS) version 25 was used for analysis. The prevalence of early sexual debut was 22.6% among female and 22.1% among male, respectively. Age was associated with early sexual debut (X2(1) = 5.992, p = 0.018), with more of the adolescents (37.4%) older than 14 year found to have had sexual intercourse at or before 14 years. Gender was associated with early sexual debut among adolescents (X2(1) = 22.898, p = 0.000). Schooling status of adolescents was associated with early sexual debut (p = 0.000). Respondents who drink alcohol were three times more likely to have early sexual debut (COR = 3.28, at 95% CI (1.530–7.031)) and there was a strong association between drinking alcohol and early sexual debut (p = 0.000). Having ever had peer influence (p = 0.03) was associated with early sexual debut. So, conclusively, the proportion of girls who delay sex is slightly higher as compared with that of boys. Early sexual debut and associated factors among adolescents in Kasawo Sub-county, Mukono district, UgandaAll authors Kizito Omona & Jonathan Kizito Ssuka https://doi.org/10.1080/27707571.2023.2183561 Published online 07 March 2023 Display full size

COVID-19 has had uneven impacts on health and well-being, with Indigenous communities in the Global South facing some of the highest risks. Focusing on the experience of Sri Lanka, this study identifies key policy responses to COVID-19, documents how they evolved over two years of the pandemic, and examines if and how government responses have addressed issues pertaining to Indigenous Peoples. Drawing upon an analysis of policy documents (n = 110) and interviews with policymakers (n = 20), we characterize seven key policy responses implemented by the Sri Lankan government: i) testing for and identifying COVID-19; ii) quarantine procedures; iii) provisional clinical treatments; iv) handling other diseases during COVID-19; v) movement; vi) guidelines to be adhered to by the general public; and vii) health and vaccination. The nature of these responses changed as the pandemic progressed. There is no evidence that policy development or implementation incorporated the voices and needs of Indigenous Peoples.

Background: Despite a plethora of literature on barriers to addressing future fertility in childhood cancer survivors, the data are not representative of limited middle-income settings. Unique and context-specific factors may influence addressing future fertility care among childhood cancer survivors in Uganda. This study aimed to explore the experiences, attitudes, and perceptions of parents on their interactions with health providers about future fertility, as part of their child's cancer survivorship. Methods: Using grounded theory, semistructured interviews were conducted with parents of children diagnosed with cancer, <18 years of age, and not in the induction or consolidation phases of treatment. Transcripts were thematically analyzed. Results: A total of 20 participants were interviewed, with the majority identifying as female (n = 18). The global theme that arose was the importance of shared decision-making, and the key themes encompassing this were as follows: (1) importance of accurate information, (2) respect of autonomy, and (3) engagement and psychosocial support. Conclusion: In Uganda, parents of children with cancer value a multifaceted approach to satisfactory decision-making within the context of oncofertility.

Background: DNA-methylation has been associated with plasma lipid concentration in populations of diverse ethnic backgrounds, but epigenome-wide association studies (EWAS) in West-Africans are lacking. The aim of this study was to identify DNA-methylation loci associated with plasma lipids in Ghanaians. Methods: We conducted an EWAS using Illumina 450k DNA-methylation array profiles of extracted DNA from 663 Ghanaian participants. Differentially methylated positions (DMPs) were examined for association with plasma total cholesterol (TC), LDL-cholesterol, HDL-cholesterol, and triglycerides concentrations using linear regression models adjusted for age, sex, body mass index, diabetes mellitus, and technical covariates. Findings were replicated in independent cohorts of different ethnicities. Findings: We identified one significantly associated DMP with triglycerides (cg19693031 annotated to TXNIP, regression coefficient beta −0.26, false discovery rate adjusted p-value 0.001), which replicated in-silico in South African Batswana, African American, and European populations. From the top five DMPs with the lowest nominal p-values, two additional DMPs for triglycerides (CPT1A, ABCG1), two DMPs for LDL-cholesterol (EPSTI1, cg13781819), and one for TC (TXNIP) replicated. With the exception of EPSTI1, these loci are involved in lipid transport/metabolism or are known GWAS-associated loci. The top 5 DMPs per lipid trait explained 9.5% in the variance of TC, 8.3% in LDL-cholesterol, 6.1% in HDL-cholesterol, and 11.0% in triglycerides. Interpretation: The top DMPs identified in this study are in loci that play a role in lipid metabolism across populations, including West-Africans. Future studies including larger sample size, longitudinal study design and translational research is needed to increase our understanding on the epigenetic regulation of lipid metabolism among West-African populations. Funding: European Commission under the Framework Programme (grant number: 278901).

The excessive application of mineral fertilizers in maize cultivation leads to progressive soil contamination in the long term and increases the cost of production. An alternative to reduce over-fertilization is to perform a partial replacement with microbes that promote nutrition and growth, such as Arbuscular Mycorrhizal Fungi (AMF). A pot experiment which was followed by two field experiments was performed with and without the application of indigenous AMF in combination with five nitrogen–phosphorus–potassium (NPK) fertilization rates (100% NPK = N120P60K60; 75% NPK = N90P45K45; 50% NPK = N60P30K30; 25% NPK = N30P15K15; control = N0P0K0). The objective was to investigate whether the soil application of indigenous mycorrhizal fungi inoculum combined with NPK fertilization can provide higher maize yields and soil-available N, P, and K than chemical fertilization can alone. The greenhouse results showed that the application of AMF with a 50% NPK treatment significantly increased the plant’s growth, root colonization, leaf chlorophyll content, and N, P, and K tissue content. The results from the field conditions showed that there was a highly significant yield after the treatment with AMF + 50% NPK. The study also revealed that mycorrhizal fungi inoculation increased the available soil N and P concentrations when it was combined with a 50% NPK dose. This suggests that the inoculation of fields with AM fungi can reduce the chemical fertilizer application by half, while improving soil chemistry. The results suggested that AMF inoculation can be used in integrated soil fertility management strategies.

Background This study investigated the spatial distribution of wild ungulates that pastoralist communities perceive as culprits in the transmission of cattle diseases outside protected areas in southwestern Uganda. Diseases are hypothesized as having influence on pastoralists’ choice of cattle breed types. Until now, there have been no studies conducted on spatial patterns of wild animal species association with cattle breeds reared in Lake Mburo Conservation Area (LMCA), and how diseases transmitted therein potentially influence cattle breed herd sizes.Methods Animal population survey was carried out on cattle and wild ungulate species along transect lines laid perpendicular to the northern boundary of Lake Mburo National Park (LMNP). Data on the costs of cattle mortality and disease control were gathered using face-to-face interviews. We used SPSS version 17 for descriptive statistics to summarize unit cost of disease control at herd level, whereas chi-square (χ2) tests of goodness-of-fit were used to analyze observations on frequency of wild animal sightings, whose association with spatial distribution patterns of cattle breeds was examined using Pearson correlation test.ResultsOur results show inverse association of distance away from LMNP with wild animal populations and the cost of cattle disease control. The mean population of exotic cattle significantly increased as that of indigenous cattle decreased with increasing distance from LMNP. In a similar way, the cost of disease control and cattle abortion incidences were much lower in rangelands far away from LMNP (R2 = 0.965, p < 0.001).Conclusion Spatial distribution of wild ungulates was significantly associated with reported cattle mortality, disease, and cost of disease control. Diseases and their costs of control potentially influenced spatial patterns of cattle breeds and breed herd sizes in LMCA, which in turn could affect range resource use for conserving different species of wild animals outside protected area.

Background Studies in various countries including Uganda and Kenya have shown a much lower incidence of the human immunodeficiency virus (HIV) among men that underwent voluntary medical male circumcision (VMMC) compared to uncircumcised men. Wakiso district, the district with the highest prevalence of HIV in Uganda (7%), has a very low estimated proportion of men who have undergone VMMC (30.5%). Within the district, various public health facilities provide free VMMC services. This study examined the prevalence and factors associated with the uptake of VMMC among men attending the outpatient department (OPD) of a public facility offering VMMC services. Methods We conducted a cross-sectional study between July to August 2021 using a sample of men attending the OPD at Kira Health Centre IV. We defined VMMC uptake as the removal of all or part of the foreskin of the penis by a trained healthcare professional. We determined factors independently associated with VMMC uptake using a modified Poisson regression analysis with robust standard errors at a 5% statistical significance level. Adjusted prevalence risk ratios (APRR) were reported as the measure of outcome. Results Overall, 389 participants were enrolled in the study. The mean age of the participants was 27.2 (standard deviation ± 9.02) years. The prevalence of VMMC uptake was 31.4% (95% Confidence Interval [CI] 26.8–36.2). In the adjusted analysis, the uptake of VMMC among men attending the OPD of Kira HC IV was less likely among married participants compared to unmarried participants (APRR 0.64, 95% CI 0.48–0.88), among participants from Western tribes (APRR 0.50, 95% CI 0.41–0.86) or Eastern tribes (APPR 0.31, 95% CI 0.13–0.72) compared to participants from the Central tribes and among participants who didn’t disclose their sexual partner number compared to those that had one or no sexual partner (APRR 0.62, 95% CI 0.40–0.97). On the other hand, the prevalence of uptake of VMMC was 7 times among participants who were aware of VMMC compared to those who were not aware of VMMC (APRR 7.85 95% CI 1.07–9.80) and 2.7 times among participants who knew their HIV status compared to those that didn’t know (APRR 2.75, 95% CI 1.85–4.0). Also, the uptake of VMMC was 85% more among participants who knew that Kira HC IV provided free VMMC services compared to those that didn’t (APRR 1.85, 95% CI 1.85–4.08). Conclusion VMMC among men attending the OPD at the largest public healthcare facility proving free VMMC services in Kira Municipality was low. The OPD may provide a quick win for improving VMMC uptake. Collaborative efforts among the administration of Kira HC IV, the Ministry of Health and VMMC implementation partners could work towards developing health-facility-based strategies that can improve VMMC awareness and uptake with emphasis on the OPD.

Low uptake of family planning among women is predominantly attributed to low participation of men in postpartum family planning. In order to improve maternal health, strengthening male participation in family planning is an important public health initiative. This study aimed to assess factors associated with participation of men in postpartum care at Kiswa Health Centre III, Nakawa division, Kampala. An analytical cross-sectional study design involving collection of quantitative data was used. Systematic random sampling was used to select study participants. Data was collected using semi-structured questionnaires. Data entry and cleaning was performed using EpiData version 12 and analysed using Stata version 14. 80.0% of respondents participated in postpartum family planning. Approval of family planning use, knowledge on family planning and information source were significantly associated with male involvement in postpartum family planning. Respondents who approved family planning use at home were 15.5 times more likely to get involved in family planning services as compared to those who didn’t approve family planning. Conclusively, there was a generally high level of male involvement in postpartum family planning in comparison with the national levels. Approval of family planning at home increased the likelihood of men’s participation in family planning. • IMPACT STATEMENT • What is already known on this subject? Evidence has it that short birth intervals of less than 15 months have been found to be associated with adverse pregnancy outcomes including induced abortions, miscarriages, preterm births, neonatal and child mortalities, still births and maternal depletion syndrome. In Africa, generally, low family uptake among women is also attributed to low men participation in postpartum family planning. • What do the results of this study add? Approval of family planning use, knowledge on family planning and information source were associated with male involvement in postpartum family planning. Respondents who approved family planning use at home were 15.5 times more likely to get involved in postpartum family planning services as compared to those who didn’t approve family planning. • What are the implications of these findings for clinical practice and/or further research? In this study, the involvement of men was relatively high, but more studies are needed in other locations to compare with this finding. Otherwise, consolidation of such high involvement is highly needed, as this can be a starting point for further improvement.

Analysis of frequency and severity of droughts is critical for assessing the availability of surface water in ecosystems and for water resource planning. This study investigated hydrometeorological drought in the Upper Mzingwane sub-catchment using the standardised precipitation index (SPI) and reconnaissance drought index (RDI). Precipitation, minimum and maximum temperature data from three stations in the sub-catchment were used to calculate RDI and SPI for the period 1990–2020. Two-tailed Mann–Kendall and Pettitt tests were conducted to identify trends and breaks in the RDI and SPI values. The results showed that the sub-catchment was mainly afected by mild (62%) and moderate (20%) droughts. Signifcant increasing trends were observed for the calculated 6- and 12-month SPI and RDI values (p<0.05), indicating a decreasing trend in long-term hydrological droughts. No trend was observed for the 3- and 6-month SPI and RDI values (p>0.05). The Pettitt test did not detect any breaks in the RDI and SPI values. SPI and RDI showed strong correlation coefcients (0.93–0.99) over similar time periods. Thus, both indices behaved in the same manner across multiple time intervals (3, 6, 9 and 12 months), but RDI was more sensitive to climatic conditions because its formulation incorporates potential evapotranspiration. Approximately 14–16 droughts of varying severity occurred in the sub-catchment from 1990 to 2020. Despite increasing precipitation pattern, the catchment was still vulnerable to drought and this could undermine the ability of the catchment to deliver requisite ecosystem services such as water provision. Thus, drought forecasting, and information dissemination will be crucial to help stakeholders better prepare for future droughts in the sub-catchment

Maternal near misses (MNM) involve near-death experiences and are associated with severe maternal morbidity, not limited to severe postpartum haemorrhage, sepsis and organ dysfunction. Maternal near-misses are quite common in Ugandan health facilities. This study aimed to assess the prevalence and determinants of maternal near misses among women who sought obstetric care from Fort Portal Regional Referral Hospital, western Uganda. A retrospective cohort study that targeted 375 women who had received maternal healthcare services from Fort Portal regional referral hospital was undertaken. It was found that, overall, the prevalence of MNM was 61.3%, with sepsis being the commonest determinant [187(81.3%)]. Eight individual characteristics had statistically significant relationships with MNM; residence type (p = 0.000), trimester of initiation of ANC (p = 0.000), ANC attendance (p = 0.048), delivery of recent pregnancy in health facility (p = 0.000), delivery at Fort Portal regional referral hospital (p = 0.000), referred from other facilities (p = 0.000), age (p = 0.037), marital status (p = 0.000) and district of residence (p = 0.000). The prevalence of MNM was higher among women who were of rural residence at 45.6% (aPR = 1.409 [1.330–1.493], p = 0.000), compared to those who were of urban residence. MNM prevalence was very high among mothers who never attended ANC at 3.2% and thus, less among those who had attended ANC during pregnancy (cPR = 0.652 [0.216–0.981], p = 0.048). Conclusively, the prevalence of MNM was substantially high.

Purpose: To establish the extent of self-reported reproductive failure associated with cancer treatment, and attitudes toward fertility among adolescent and young adult (AYA) cancer survivors in Uganda. Methods: A registry-based computer-assisted telephone interview survey was conducted in Uganda. The survey population were survivors of childhood, adolescent and early adulthood cancers diagnosed between 2007 and 2018. The survey explored fertility outcomes, experiences of oncofertility and fertility attitudes of AYA cancer survivors. Results: Thirty-four (female = 14 and male = 20) interviews were completed. Survivors were 18-35 years of age. The median age at cancer diagnosis was 23.5 for females and 17.5 for males. Kaposi's sarcoma contributed to 44% of primary cancer diagnoses. All the survivors had received chemotherapy alone or in combination with other modalities and 79% of survivors had not received satisfactory information about future fertility before cancer treatment. Twenty one percent of males and 46% females met the criteria for infertility and 60% of these had met this criterion after their cancer diagnosis. Eighty two percent wanted to raise a biologically related child. Forty seven percent would be dissatisfied with their lives if they were unable to have a child or additional children. Conclusion: AYA cancer survivors in this low-resource setting reported reproductive failure, despite a strong fertility desire. Information and counseling provided on therapy-related problems before cancer treatment was insufficient and reinforces the need to build capacity for oncofertility resources within the region.

Improving livelihoods in Rwanda requires overcoming food insecurity and malnutrition. Vision 2050 is Rwanda’s long-term development strategy, yet little is known about its potential trade-offs for the country’s biodiversity, forest cover, and greenhouse gas (GHG) emissions. Scenario analysis can provide insights into how to achieve such goals more sustainably. Here, we use the Food, Agriculture, Biodiversity, Land-Use, and Energy (FABLE) Calculator, a simple integrated assessment tool, to explore potential sustainability implications by 2050 through two scenarios: (1) Current Trends and (2) Vision 2050. The Vision 2050 pathway incorporates components of the government’s long-term development strategy and associated national agricultural policy targets. It includes greater increases in crop productivity and decreases in post-harvest losses, and shifts to more sustainable diets, compared to the Current Trends pathway. Results show that the Vision 2050 pathway would, relative to Current Trends, lead to a greater decrease in agricultural land area and an increase in non-forested natural land-cover area, with consequent decreases in GHG emissions from agriculture, increases in carbon sequestration, and increases in the share of land that can support biodiversity conservation. Shifts to a healthier diet in the Vision 2050 pathway would only be compatible with national agricultural priorities if these diets favor consumption of foods that underpin sustainable livelihoods in Rwanda, such as beans, cassava, potatoes, sweet potatoes, banana, and corn. We discuss the potential for integrated land-use planning and adoption of agroecological farming practices to help Rwanda achieve food security, livelihood, biodiversity, and climate mitigation goals in tandem.

Introduction Chest trauma is one of the most important and commonest injuries that require timely diagnosis, accounting for 25–50% of trauma related deaths globally. Although CT scan is the gold standard for detection of haemothorax, it is only useful in stable patients, and remains unavailable in most hospitals in low income countries. Where available, it is very expensive. Sonography has been reported to have high accuracy and sensitivity in trauma diagnosis but is rarely used in trauma patients in low income settings in part due to lack of the sonography machines and lack of expertise among trauma care providers. Chest X-ray is the most available investigation for chest injuries in low income countries. However it is not often safe to wheel seriously injured, unstable trauma patients to X-ray rooms. This study aimed at determining the efficacy of extended focused assessment with sonography for trauma (eFAST) in detection of haemothorax using thoracostomy findings as surrogate gold standard in a low resource setting. Methods This was an observational longitudinal study that enrolled 104 study participants with chest trauma. Informed consent was obtained from all participants. A questionnaire was administered and eFAST, chest X-ray and tube thoracotomy were done as indicated. Data were analysed using SPSS version 22. The sensitivity, specificity, predictive values, accuracy and area under the curve were determined using thoracostomy findings as the gold standard. Ethical approval for the study was obtained from the Research and Ethics Committee of Kampala International University Western Campus REC number KIU-2021-53. Results eFAST was found to be superior to chest X-ray with sensitivity of 96.1% versus 45.1% respectively. The accuracy was also higher for eFAST (96.4% versus 49.1%) but the specificity was the same at 100.0%. The area under the curve was higher for eFAST (0.980, P = 0.001 versus 0.725, P = 0.136). Combining eFAST and X-ray increased both sensitivity and accuracy. Conclusion This study revealed that eFAST was more sensitive at detecting haemothorax among chest trauma patients compared to chest X-ray. All patients presenting with chest trauma should have bedside eFAST for diagnosis of haemothorax.

The earth’s resources are depleting, consequently, researchers, policymakers and change agents have shown growing concern for going green. This is premised on the thinking that human activities are affecting the earth particularly its climate, polluting the water system and general loss of living creatures. With the aim of reducing conservational decay, the Uganda government has embarked on charging environmental tax, installation of solar electricity on almost all the municipality streets, banning procurement of used vehicles and including the eco-friendly aspect in the statement of works. Stemming from this viewpoint, this study examined green procurement adoption in Sub-Saharan Africa focussing on Uganda. The researchers used an interview guide to obtain data which was analysed qualitatively. The study collected qualitative data from 10 interviewees to appreciate the nature of green procurement adoption. It presents findings that have both strategy and decision-making implications that are presented.

Background: The extent to which psychosocial stress relates to type 2 diabetes among sub-Saharan Africans is not well understood. We assessed associations of psychosocial stresses with type 2 diabetes status and glycaemic control among Ghanaians. Methods: We used data from Research on Obesity and Diabetes among African Migrants (RODAM) study. We performed logistic and linear regression models to assess association of psychosocial stresses with type 2 diabetes and HbA1c respectively with adjustments for age, sex, education, and other stresses. We also assessed moderation effects of migration status (migrant Ghanaians vs non-migrant Ghanaians), age, sex, and education by adding interaction terms in models. Results: 4841 Ghanaians were included with 44% resident in Ghana, 62% women, mean age of 46 years, and 10% having type 2 diabetes. Psychosocial stress at home and at work were not associated with type 2 diabetes or HbA1c levels. Negative life events in past 12 months were negatively associated with type 2 diabetes (adjusted Odds Ratio = 0.93, 95% CI 0.87-0.99). Perceived discrimination was positively associated with type 2 diabetes (aOR = 1.01, 95% CI 1.004-1.03). Both associations were more pronounced in men. Perceived discrimination was also positively associated with HbA1c levels, especially among those with type 2 diabetes (adjusted β = 0.01, 95% CI 0.007-0.02). Conclusions: Perceived discrimination and negative life events are associated with type 2 diabetes and glycaemic control among Ghanaians, especially in men. Further studies are needed to identify context specific mechanisms underlying these associations.

Background Previous studies of type 1 diabetes in childhood and adolescence have found large variations in reported incidence around the world. However, it is unclear whether these reported incidence levels are impacted by differences in country health systems and possible underdiagnosis and if so, to what degree. The aim of this study was to estimate both the total and diagnosed incidence of type 1 diabetes globally and to project childhood type 1 diabetes incidence indicators from 1990 to 2050 for each country. Methods We developed the type 1 diabetes global microsimulation model to simulate the natural history and diagnosis of type 1 diabetes for children and adolescents (aged 0–19 years) in 200 countries and territories, accounting for variability in underlying incidence and health system performance. The model follows an open population of children and adolescents in monthly intervals and simulates type 1 diabetes incidence and progression, as well as health system factors which influence diagnosis. We calibrated the model to published data on type 1 diabetes incidence, autoantibody profiles, and proportion of cases diagnosed with diabetic ketoacidosis from 1990 to 2020 and assessed the predictive accuracy using a randomly sampled test set of data withheld from calibration. Findings We estimate that in 2021 there were 355 900 (95% UI 334 200–377 300) total new cases of type 1 diabetes globally among children and adolescents, of which 56% (200 400 cases, 95% UI 180 600–219 500) were diagnosed. Estimated underdiagnosis varies substantially by region, with over 95% of new cases diagnosed in Australia and New Zealand, western and northern Europe, and North America, but less than 35% of new cases diagnosed in west Africa, south and southeastern Asia, and Melanesia. The total number of incident childhood cases of type 1 diabetes is projected to increase to 476 700 (95% UI 449 500–504 300) in 2050. Interpretation Our research indicates that the total global incidence of childhood and adolescent type 1 diabetes is larger than previously estimated, with nearly one-in-two children currently undiagnosed. Policymakers should plan for adequate diagnostic and medical capacity to improve timely type 1 diabetes detection and treatment, particularly as incidence is projected to increase worldwide, with highest numbers of new cases in Africa. Funding Novo Nordisk.