UNASSIGNED: Community engagement and involvement (CEI) in research usually depends on face-to-face interactions. However, the COVID-19 pandemic prevented such interactions because of national lockdowns and social distancing. This paper highlights the ways in which early career researchers from East Africa tackled CEI activities during the pandemic.
UNASSIGNED: We provide four case examples that illustrate how early-career researchers based in Kenya, Uganda and Tanzania, deployed different approaches and initiatives to community-engaged research during the pandemic to encourage participation and uptake of research findings.
UNASSIGNED: All the three early-career researchers attempted to use virtual/digital means to implement the CEI. However, in each country, this attempt was unsuccessful because of poor connectivity, as well as many poorer students lacking access to telephones and computers. Nevertheless, the researchers effectively engaged the students using different activities (making up songs, drawing comics, and taking part in quizzes) once the schools reopened.
UNASSIGNED: These results highlight the complexity of implementing community engagement and involvement in health research when face-to-face interaction is not possible. The findings are relevant to researchers who wish to incorporate community engagement in their research and initiatives.

The Upper White Nile (UWN) basin plays a critical role in supporting essential ecosystem services and the livelihoods of millions of people in East Africa. The basin has been exposed to tremendous environmental pressures following high population growth, urbanisation, and land use change, all of which are compounded by the threats posed by climate change and insufficient financial and human resources. The water-energy-food-environment (WEFE) nexus provides a framework to assess solution options towards sustainable development by minimising the trade-offs between water, energy, and food resources. However, the majority of existing WEFE nexus indicators and tools tend to be developed without consideration of practitioners at the local level, thus constraining the practical application within real-world contexts. To try to address this gap and operationalise the WEFE nexus, we examined how local stakeholders frame the most pressing WEFE nexus challenges within the UWN basin, how these can be represented as indicators, and how existing WEFE nexus modelling tools could address this. The findings highlight the importance of declining water quality and aquatic ecosystem health as a result of deforestation and increasing agricultural intensity, with stakeholders expressing concerns for the uncertain impacts from climate change. Furthermore, a review of current WEFE nexus modelling tools reveals how they tend to be insufficient in addressing the most pressing environmental challenges within the basin, with a significant gap regarding the inclusion of water quality and aquatic ecosystem indicators. Subsequently, these findings are combined in order to guide the development of WEFE nexus indicators that have the potential to spatially model the trade-offs within the WEFE nexus in the UWN basin under climate change scenarios. This work provides an example of how incorporating local stakeholder\'s values and concerns can contribute to the development of meaningful indicators, that are fit-for-purpose and respond to the actual local needs.

Livelihood initiatives are common within marine protected areas (MPAs) aiming for poverty alleviation or higher income opportunities. However, results can be mixed in reality, as well as change over time. Furthermore, who benefits is a key consideration, as results can vary based on inequalities, including gender. Here, the monetary outcomes of different livelihood strategies were investigated across three MPA regions in Zanzibar, Tanzania. Using a quantitative approach, the results show that livelihoods have shifted in a six-year period, with livelihood strategies differing in poverty incidence and income. Livelihood initiatives, namely seaweed farming and tourism, did not provide significantly higher monetary returns compared to long-standing livelihoods, such as fisheries. Seaweed farming showed income stability but a high poverty incidence predominantly within women-headed households. During the study period, men primarily remained in fisheries, whilst women shifted to small-scale businesses and fisheries, largely exiting seaweed farming. This underscores a need for adaptive, gender sensitive management within fast changing coastal contexts.

Background: In this paper, we explain how three early career researchers actively engaged community members in their health research projects in Kenya, Tanzania and Uganda, and what was learnt from the experience. The research project in Kenya was on camel trypanosomiasis and the role of camel biting keds (or louse flies) in disease transmission. The project in Tanzania looked at the effect of human immunodeficiency virus and antiretroviral therapy on fertility and ascertained the trends in the use of family planning services amongst women of reproductive age. The focus of the project in Uganda was the implementation of maternal death surveillance and the response policy to determine the cause of maternal deaths and how they might be prevented. Methods: In the three different settings, efforts to ensure local community engagement provided a focus for the researchers to hone their skills in explaining research concepts and working in partnership with community members to co-develop ideas, their research methods and outputs. Results: Involvement of communities in scientific research, which entailed a two-way mutual engagement process, led to (i) generation of new research ideas that shaped the work, (ii) strengthened mutual trust, and (iii) promoted uptake of research findings. Conclusion: Our key findings strongly support the need for considering community engagement as one of the key components in research studies.

Background: β-thalassemia is rare in sub-Saharan Africa and to our knowledge there has been no case of homozygous β-thalassemia major reported from this region. In a recent cohort study, we identified four β-thalassemia mutations among 83 heterozygous carriers in Kilifi, Kenya. One of the mutations identified was a rare β-globin gene initiation codon mutation (ATG➝ACG) (rs33941849). Here we present a patient with β-thalassemia major resulting from this mutation, only the second homozygous patient to have been reported.  Methods: The female patient presented to Kilifi County Hospital aged two years with a one week left sided abdominal swelling. Clinical, hematological and genetic information were collected at admission and follow-up.  Results: Admission bloods revealed marked anemia, with a hemoglobin (Hb) value of 6.6 g/dL and a low mean corpuscular volume of 64 fL. High performance liquid chromatography (HPLC) revealed the absence of HbA0 and elevated levels of HbF, suggesting a diagnosis of β-thalassemia major. Sequencing revealed that the child was homozygous for the rs33941849 initiation codon mutation.  Conclusions: We hope that this study will create awareness regarding the presence of β-thalassemia as a potential public health problem in the East Africa region and will prompt the development of local guidelines regarding the diagnosis and management of this condition.

Biorepositories are essential because they guarantee the proper storage and distribution of biospecimens and their associated data for current and future research. In Eastern and Central Africa, the Integrated Biorepository of H3Africa Uganda (IBRH3AU) at Makerere University in Uganda was the first of its kind. It is strategically located at Makerere University College of Health Sciences, which is home to some of Uganda\'s most relevant and impactful infectious and non-infectious disease research.  Since its inception as a pilot project in 2012, the IBRH3AU biorepository has grown into a state-of-the-art facility serving the H3Africa consortium and the rest of the scientific community. IBRH3AU has built a solid infrastructure over the past ten years with cutting-edge methods and technologies for the collection, processing, quality control, handling, management, storage and shipment of biospecimens. H3Africa researchers, local researchers, postgraduate and postdoctoral students, and the greater scientific community in Eastern and Central Africa and beyond have benefited from IBRH3AU\'s exceptional biobanking services.

Human immunodeficiency virus (HIV) and malaria infection rates overlap across sub-Saharan Africa, but factors influencing their co-occurrence are unclear. In a case-control study, we investigated whether malaria exposure increases risk of type 1 (HIV-1) acquisition. Prior to seroconverting, HIV-positive cases had significantly higher malaria-associated antibodies compared to HIV-negative controls, linking malaria exposure to HIV-1 acquisition.

Gambling activities and associated mental health problems have become a topic of increased concern globally. Many individuals with a severe gambling disorder have gambling-related suicidality. However, no study has explored gambling-related suicide in East African Community (EAC) countries. The present study investigated the press media reporting of gambling-related suicide cases from EAC countries.
As there is no established suicide database in that region, media reports were utilized to collect gambling-related suicide data. Gambling-related suicide case reports were searched for in EAC countries\' press media websites using Google. After removing duplicates, a total of 18 suicides were found.
The victims were all males aged 16 to 40 years. The most prevalent reason for the death was university students who had used their university tuition fees for gambling and losing the money (n = 4/17). All the suicide deaths were in Kenya (10/18), Uganda (7/18), and Tanzania (1/18). Betting on soccer was the most common type of gambling reported (n = 11/15), and hanging was the most used mode of suicide (n = 10/16).
Based on the press media reports, 18 males were identified as having carried out gambling-related suicides. The countries with the most widespread opportunities to gamble had more gambling-related suicides, although the number of suicides was very small.

Rapid case ascertainment (RCA) refers to the expeditious and detailed examination of patients with a potentially rapidly fatal disease shortly after diagnosis. RCA is frequently performed in resource-rich settings to facilitate cancer research. Despite its utility, RCA is rarely implemented in resource-limited settings and has not been performed for malignancies. One cancer and context that would benefit from RCA in a resource-limited setting is HIV-related Kaposi sarcoma (KS) in sub-Saharan Africa.
To determine the feasibility of RCA for KS, we searched for all potential newly diagnosed KS among HIV-infected adults attending three community-based facilities in Uganda and Kenya. Searching involved querying of electronic medical records, pathology record review, and notification by clinicians. Upon identification, a team verified eligibility and attempted to locate patients to perform RCA, which included epidemiologic, clinical and laboratory measurements.
We identified 593 patients with suspected new KS. Of the 593, 171 were ineligible, mainly because biopsy failed to confirm KS (65%) or KS was not new (30%). Among the 422 remaining, RCA was performed within 1 month for 56% of patients and within 3 months for 65% (95% confidence interval: 59 to 70%). Reasons for not performing RCA included intervening death (47%), inability to contact (44%), refusal/unsuitable to consent (8.3%), and patient re-location (0.7%).
We found that RCA - an important tool for cancer research in resource-rich settings - is feasible for the investigation of community-representative KS in East Africa. Feasibility of RCA for KS suggests feasibility for other cancers in Africa.

Chronic undernutrition in children continues to be a global public health concern. Ethiopia has documented a significant decline in the prevalence of childhood stunting, a measure of chronic undernutrition, over the last 20 y.
The aim of this research was to conduct a systematic assessment of the determinants that have driven child stunting reduction in Ethiopia from 2000 to 2016, focused on the national, community, household, and individual level.
This study employed both quantitative and qualitative methods. Specifically, a systematic literature review, retrospective quantitative data analysis using Demographic and Health Surveys from 2000-2016, qualitative data collection and analysis, and analyses of key nutrition-specific and -sensitive policies and programs were undertaken.
National stunting prevalence improved from 51% in 2000 to 32% in 2016. Regional variations exist, as do pro-rich, pro-urban, and pro-educated inequalities. Child height-for-age z score (HAZ) decomposition explained >100% of predicted change in mean HAZ between 2000 and 2016, with key factors including increases in total consumable crop yield (32% of change), increased number of health workers (28%), reduction in open defecation (13%), parental education (10%), maternal nutrition (5%), economic improvement (4%), and reduced diarrhea incidence (4%). Policies and programs that were key to stunting decline focused on promoting rural agriculture to improve food security; decentralization of the health system, incorporating health extension workers to improve rural access to health services and reduce open defecation; multisectoral poverty reduction strategies; and a commitment to improving girls\' education. Interviews with national and regional stakeholders and mothers in communities presented improvements in health service access, women and girls\' education, improved agricultural production, and improved sanitation and child care practices as drivers of stunting reduction.
Ethiopia\'s stunting decline was driven by both nutrition-specific and -sensitive sectors, with particular focus on the agriculture sector, health care access, sanitation, and education.