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Recent Submissions
Efficient energy usage typologies: Adoption and determinants of energy-saving appliances among Ugandan households
(Elsevier, 2026-01-24) Mubiinzi Geoffrey; Senyonga Livingstone; Kigongo Kaawaase Twaha; wasswa Francis; Adaramola Muyiwa S.; Nantongo Maria
This study investigates household adoption of energy-efficient technologies in Uganda using nationally representative data from the Uganda National Household Survey 2020/21. We develop an integrated econometric framework that combines Latent Class Analysis (LCA), Multinomial Logit (MNL) models, and Logistic and Poisson regressions to capture adoption heterogeneity, identify structural determinants, and differentiate between adoption incidence and intensity. LCA probabilistically classifies households into four adoption typologies: nonadopters, lighting-only adopters, heating-only adopters, and broad adopters. MNL models quantify the demographic, geographic, and infrastructural factors that shape class membership, whereas logistic and Poisson specifications reveal who adopts at least one technology and how deeply it extends across multiple domains. The results showed that over 90 % of the households remained non-adopters, with efficient lighting as the primary entry point, minimal cooking, and virtually no heating. Adoption is consistently constrained by electricity access, affordability, and household asset levels, whereas urban residences, education, and younger household heads significantly increase the likelihood of adoption. By integrating latent adoption typologies with incidence–intensity modeling using nationally representative household data, this study advances beyond conventional binary adoption analyses and provides robust, policy-relevant evidence on the structural constraints shaping Uganda’s household energy transition.
Comment on ‘Lean, Non-Autoimmune Young-Onset Diabetes in Bangladesh
(John Wiley & Sons Ltd, 2026-10-06) Wadivkar Pradnayshree; Bahendeka Silver; Kibirige Davis
We read with great interest the article by Hasan et al., which evaluated the metabolic profile of lean non-autoimmune young-onset diabetes in Bangladesh [1]. We commend the authors for evaluating an important but neglected diabetes phenotype among low- and normal-BMI young individuals, potentially affecting millions of individuals in low-income settings. We appreciate that the authors narrowed down the phenotype by excluding participants with pancreatic pathology, monogenic variants and fasting C-peptide levels below 200 pmol/L.
The study's ‘lean’ category in the main text combines participants with BMI < 18.5 kg/m2 and those with BMI 18.5–22.9 kg/m2. Given that the authors concluded that these ‘lean’ subjects have modest insulin resistance and metabolic dysfunction, we looked with interest at the BMI-based sub-analysis (in the supplementary material) and at whether the leanest subjects were insulin-resistant. Of the 53 lean DM participants, only 9 had BMI < 18.5 kg/m2. The authors reported that low- and normal-BMI DM participants showed similar phenotypic and metabolic features. However, we wanted to highlight that the waist-hip ratio, waist circumference and waist-height ratio (p = 0.033) were lower in the low-BMI DM group than in the normal-BMI DM group. Additionally, median triglycerides were much lower (within the normal range and closely matching the median for the lean non-DM group) in the low-BMI DM subgroup than in the normal-BMI subgroup. Median HOMA2-IR, fasting C-peptide and fasting insulin were also lower in the low-BMI DM group than in the normal-BMI group. We recognize that none of these differences were significant except for the waist-height ratio. However, the direction and magnitude of the differences are consistent across nearly every relevant variable. The low-BMI DM subgroup appears consistent with the recently classified Type 5 Diabetes (T5D) phenotype cited in this paper, and we believe repeat laboratory and statistical measurements would help clearly distinguish it as a distinct phenotype.
Regarding lipid data in the article by Hasan et al., measurements were obtained cross-sectionally from participants with severe, uncontrolled hyperglycemia, without prior correction of glucotoxicity, as mentioned by the authors. The median HbA1c in the lean DM subgroup was 11.6%, which may have contributed to the apparent dyslipidemia in this group. The same caution applies to HOMA2-IR, since insulin resistance estimated during severe hyperglycemia is inflated by glucotoxicity and does not necessarily reflect participants' baseline state [2]. Therefore, the glucose, lipid and HOMA-IR values used by the authors to identify ‘metabolic dysfunction’ in the lean DM group may, in fact, primarily reflect glucotoxicity. Therefore, we propose that repeating these measurements after correcting for glucotoxicity would help assess insulin sensitivity in this group.
We wanted to clarify a few points about the T5D phenotype, which is characterized by BMI < 18.5 kg/m2 [3]. Despite ongoing ambiguities regarding optimal diagnostic cut-offs and whether anthropometric measurements are obtained at initial presentation or following metabolic stabilization, we recognize that exposure to persistent undernutrition remains one of the crucial characteristics of T5D. A detailed nutritional history of the study participants would help assess their nutritional status, although it can be challenging in resource-limited areas. This challenge could be addressed using the Global Leadership Initiative on Malnutrition (GLIM) criteria [4], which combine simple, validated phenotypic and etiologic measures to identify malnutrition in adults. Additionally, the study participants were recruited from a young diabetes clinic at a tertiary referral centre in urban Dhaka. T5D is primarily reported in rural and socioeconomically disadvantaged populations [5, 6]. It may also be helpful to obtain data on other factors, such as intentional weight loss, genetic factors, or infections like HIV and TB, that may interact with insulin secretion and action, leading to lower BMI.
Thus, the cohort provides valuable characterization of lean, urban young-onset non-autoimmune diabetes. This is such an important diabetes phenotype that expanding catchment areas to include rural and socioeconomically deprived regions would also help identify individuals with this phenotype. Additionally, it would be of particular interest if future studies examining this condition correct glucotoxicity before analysing insulin sensitivity using HOMA-IR. Given Bangladesh's burden of young-onset diabetes, targeted recruitment of underweight participants with diabetes would be a substantial contribution, and this group appears well placed to undertake it.
Measuring health facility readiness for obstetric fistula surgery and care in Busoga sub-region, eastern Uganda
(African Journal of Urology, 2026-10-19) Peter Kivunike Mukasa; Mary Kinney; Steven Katende; Wilberforce Mugwanya; Abdmagidu Menya; Smule Kizza Sajjabi; Alison El Ayadi; Debra Jackson
Background: Obstetric fistula (OF) remains a devastating injury in Uganda, with an estimated 90% of needs unmet. Service delivery through temporary repair camps, rather than integrated routine surgical programs, limits the health system's capacity to address backlogs and ensure quality. A critical initial step for transitioning to integrated routine OF care is assessing facility readiness; however, no standardized framework exists in Uganda for this purpose. Objective: To develop a consensus-based facility readiness scoring criteria and framework for obstetric fistula surgery and care and apply that criteria to assess the readiness of six hospitals in eastern Uganda. Materials and Methods: This study utilized a two-phase approach. Phase I involved developing a consensus-based scoring framework adapted from WHO and UNFPA guidelines. Phase II conducted a cross-sectional readiness assessment of six hospitals between May and July 2024. Readiness was evaluated across seven weighted domains: human resources, infrastructure, equipment and supplies, supportive services, clinical protocols, monitoring systems, and management accountability. Results: A 23-expert panel validated the seven-domain framework in April 2024. Readiness scores across the six facilities ranged from 38% to 84%. Only one facility met the predefined readiness threshold (≥ 80%). Two hospitals demonstrated partial readiness (65–69%), while three were classified as not ready. Human resources were the principal constraint, with only one hospital employing a resident fistula surgeon. While basic infrastructure including water, electricity, and operating theatres was largely adequate, fistula-specific capacity was consistently limited. Most facilities lacked complete surgical instrument sets, specialized equipment, monitoring systems, and standardized clinical protocols. Conclusion: The developed consensus-based readiness criteria offer a practical tool for identifying capacity gaps and supporting the decentralization of OF services in low-resource settings. Most hospitals in this region currently lack the structural readiness required for routine fistula surgery, primarily due to significant deficits in specialized human resources, fistula-specific equipment, and clinical governance.
Household electric energy efficiency
(ELSEVIER, 2026-08-27) Mubiinzi Geoffrey; Senyonga Livingstone; Kigongo Kaawaase Twaha; Wasswa Francis; Adaramola Muyiwa S.; Nantongo Maria
This study examines household electric energy efficiency in Uganda by assessing how effectively households convert electricity and complementary domestic conditions into welfare-relevant services. The issue is important because electricity access and electricity consumption do not automatically translate into useful household outcomes, especially where reliability, housing quality, appliance ownership, and household resources differ. Using Uganda National Household Survey 2020/2021 data, the study constructs a household electricity-service proxy from electricity-enabled service assets and estimates household efficiency using stochastic frontier analysis, followed by fractional response models, a control-function correction, and predictive validation. The results show substantial heterogeneity in household electricity-service production. The baseline frontier estimates a mean technical efficiency of 0.604, with a median of 0.621 and a 90th percentile of 0.860, indicating that many electricity-using households operate below best-practice service performance. Efficiency is also unequal, with a Gini coefficient of 0.194 and a 90th-to-10th percentile ratio of 3.155. Electricity consumption and daily power availability are positively associated with service output, but the electricity-consumption elasticity is small, at 0.071 under the baseline specification, suggesting less than proportional service gains from additional electricity use. Efficiency is systematically associated with household assets, housing quality, literacy, household composition, electricity cost, and regional location. The evidence provides a service-oriented basis for identifying where household electricity benefits remain constrained. The study concludes that household electricity policy should move beyond connection and consumption metrics toward improving reliability, domestic service conditions, and the household capabilities that shape electricity-service performance.
Citizenship moods in the late Museveni era: a cartoon-powered analysis
(Routledge, Taylor & Francis, 2023-07-28) Ssentongo, Jimmy Spire; Alava Henni
This article develops the concept of citizenship moods to analyze citizens’ emotional (dis)engagements with the state in Uganda. Through a reflexive analysis of ethnographic and media material from 2019–2021, we claim that around the time of the 2021elections, after 35 years of rule by Yoweri Museveni’s National Resistance Movement, the most prevalent moods among Ugandans were fear, contentment, cynicism, anger, hope, and despondency. Prior to the elections, hope soared, but this gave way to despondency following the state’s violent crack-down on opposition. Building on work on citizenship, affect, emotion, and politics, we theorise that citizenship moods are experienced both individually and collectively; coexist, transform, and fluctuate over time; and affect and are affected by political and societal change. In Uganda, a key change is the growth of intersecting ethnic, regional, generational, and class inequalities. Citizenship moods structure, transform, and vitalise the relationship between the state and its citizens, and analysing them contributes to imagining the possibilities of democratic change in Uganda and beyond. The article introduces a method of cartoon-powered sociopolitical analysis. The inherent attunement of cartoons to bodily postures and expressions enables analytical insight and effective communication of research results, and can contribute to advancing research justice.