Spatial Disparity in Availability of Tuberculosis Diagnostic Services Based on Sector and Level of Care in Nigeria

Background: Delay in Tuberculosis (TB) diagnosis can contribute to late presentation, severe disease, and continued transmission. KNCV TB Foundation Nigeria through the United States Agency for International Development (USAID) funded the TB Local Organization Network (LON) 1 and 2 projects that explored the availability of Tuberculosis services based on sector and levels of care. Methods: TB Patient Pathway Analysis was carried out in 14 states comprising 92 facilities. It involved primary, secondary, and tertiary levels of health care in both the public and private sectors. This was a cross-sectional study under program implementation. Proforma was used to collect data on the available TB diagnostic services. Results: In public health facilities, GeneXpert was available at 100% in tertiary facilities in 8 (57%) states;up to 82% in 4 (33%) states, 50% available at secondary facilities in 2 states, and There is none at the primary facilities. Smear microscopy was available at 100% in tertiary facilities in 9 (64%) states and 3 (25%) states have 50% to 82%;secondary -10 (71%) states have > 70% at facilities;primary 1 (7%) state has it in 61% of facilities. Loop-mediated isothermal amplification (TB-LAMP) in tertiary 2 (17%) states have 20% and 100% respectively;secondary 4 (<30%) states have in 1 or 2 facilities;none for primary facilities. In private health facilities, 79% of states have Smear microscopy at both primary and secondary facilities, and only 2 states (14%) at tertiary facilities. Only 1 (7%) state has GeneXpert in all tertiary facilities, 2 (14%) states have secondary facilities, and 4 states in about 1% of facilities. TB LAMP was not available in any tertiary facility, one (7%) state at secondary with coverage of 1%, and 2 (14%) states at primary both with 4% overall facility coverage. Conclusions: There is an inequitable distribution of TB diagnostic services in both sectors and levels of care in Nigeria. TB care and control will improve with enhanced equitable distribution of TB diagnostic services across the health system.

Routine Supportive Supervision and Management of Medicines and Other Health Products and Technologies in Vihiga County, Kenya

Health Products and Technologies (HPTs) are pivotal for an efficient health system. Availability and accessibility to affordable health products are critical indicators towards achieving universal health coverage. Routine supportive supervision, performance monitoring, recognition of efforts and client feedback are vital activities toward health supply chain system strengthening. This is a descriptive paper that describes a model of integrated commodity supportive supervision, and mentorship and its impact on various outcomes of health commodity management. Data were abstracted from the standardized scored checklists used during integrated commodity supportive supervision and supply chain audit in public health facilities in Vihiga County. Scores for the period 2020 to 2022 were analyzed on the eight key areas of interest. The analysis was done using Statistical Package for Social Sciences (SPSS version 26). Results are interpreted at 95% Confidence interval. This paper also shares findings from both quantitative and qualitative data from client exit and facility managers’ interviews. Six complete rounds of supervisions, three clients and service providers’ interviews, and three annual award events have been conducted. We observed trends across six data collections points and compared the results at first point or baseline (January-June 2020) to the results at the last point or end line (April-June 2022). Findings show significant improvements on the eight parameters in terms of mean scores as follows: resolution of issues from previous visits by 35.06% (46.75% - 81.81%);storage of HPTs by 17.41% (68.72% - 86.13%);inventory management by 28.16% (42.67% - 70.83%);availability and use of commodity data management information systems (MIS) tools by 22.39% (74.40% - 96.79%);verification of commodity data by 25.61% (65.56% - 91.17%);availability of guidelines and job aids for commodity management by 46.28% (36.65% - 82.93%). There was an improvement on the mean score on accountability by 20.22% (58.58% - 83.51%). The composite (final) score improved by 28.33% (56.19% - 84.52%). There was progressive narrowing of the standard deviations on all the indicators across the study period. This demonstrates that there is standardization of practices and positive competition among all the public health facilities. There were significant improvements on all the eight indicators. Routine integrated commodity supportive supervision has proven to be an effective high impact intervention in improving management of health products and technologies in Vihiga County, Kenya.

Patient Health Seeking Behavior and Choice of Place of Care among Tuberculosis Clients in Selected States in Nigeria

Background: Tuberculosis (TB) remains a major global public health problem. Early detection and initiation of treatment shortens infectious period and is key to TB control. A considerable proportion of TB patients presenting with advanced symptoms suggests delay in seeking care. As TB control programs rely on passive case finding, TB care-seeking behavior is critical as un-diagnosed cases act as reservoirs for transmission. This study assessed patient health seeking behavior and choice of place of care among TB patients in Nigeria. Methods: This was a pro-gramme implementation, facility-based cross-sectional study in 14 states, 92 facilities across three levels of care. Interviewer-administered semi-structured questionnaires were used. Information on personal characteristics and health seeking behavior was collected from June 2020 to December 2021. The analysis was based on the various healthcare providers where the respondents first sought care. Data analysis was done using IBM SPSS and summarized using frequency and percentages. Chi square test was used for associations of characteristics of patients and choice of place of care at p Results: In all 14 states, distribution of overall first place of seeking care for TB symptoms was: 7208 (75.8%) health facilities (range 57% to 88%), while 2294 (24.2%) visited other places including community pharmacist, patent medicine vendor, traditional/home, un-specified/none. For Health facilities, the majority were at public facilities 6563 (69.1%) and private 641 (6.7%). Moreover, 6 states had >20% of respondents who first sought care at PMVs, while 3 states (Delta, Imo, and Rivers) had 10% of respondents who first sought care at Community Pharmacist. Conclusions: Nearly a quarter of people with TB first sought care outside health facilities, suggesting the need to align availability of services with their needs.

Vulnerability of Kenya’s Water Towers to Future Climate Change: An Assessment to Inform Decision Making in Watershed Management

Recent trends show that in the coming decades, Kenya’s natural resources will continue to face significant pressure due to both anthropogenic and natural stressors, and this will have greater negative impacts on socio-economic development including food security and livelihoods. Understanding the impacts of these stressors is an important step to developing coping and adaptation strategies at every level. The Water Towers of Kenya play a critical role in supplying ecosystems services such as water supply, timber and non-timber forest products and regulating services such as climate and water quantity and quality. To assess the vulnerability of the Water Towers to climate change, the study adopted the IPCC AR4 framework that defines vulnerability as a function of exposure, sensitivity, and adaptive capacity. The historical trends in rainfall indicate that the three Water Towers show a declining rainfall trend during the March-April-May (MAM) main rainy season, while the October-November-December (OND) short rainy season shows an increase. The temperature patterns are consistent with the domain having a common rising trend with a rate in the range of 0.3°C to 0.5°C per decade. Projection analysis considered three emissions scenarios: low-emission (mitigation) scenario (RCP2.6), a medium-level emission scenario (RCP4.5), and a high-emission (business as usual) scenario (RCP8.5). The results of the high-emission scenario show that the annual temperature over the Water Towers could rise by 3.0°C to 3.5°C by the 2050s (2036-2065) and 3.6°C to 4.8°C by the 2070s (2055-2085 results not presented), relative to the baseline period 1970-2000. The findings indicate that exposure, sensitivity, and adaptive capacity vary in magnitude, as well as spatially across the Water Towers. This is reflected in the spatially variable vulnerability index across the Water Towers. Overall vulnerability will increase in the water towers leading to erosion of the resilience of the exposed ecosystems and the communities that rely on ecosystem services these landscapes provide.

Determinates of Regain in Body Mass Index among Malnourished Aids Patients on Therapeutic Food in Amhara National Regional State, Northwest Ethiopia: A Retrospective Cohort Study

Although its utilization is greatly disputed, ready-to-use therapeutic food has been started as clinical nutrition care and treatment for malnourished adult AIDS patients since 2011 in Amhara National Regional State. However, factors determining the intended outcome (weight gain) have not been properly investigated. The main objective of the study was to assess improvement in body mass index and to identify its determinant factors. A retrospective cohort study design was conducted. Cluster sampling was employed to select health facilities in which the service was provided in the region. Of the 44 health facilities, nine were selected using lottery method, and all patients receiving the care in these health institutions were included in the study. Using tailored structured checklist, data were collected, organized and cleaned. Using paired T-test existence of difference between the mean of body mass index at admission and at 3rd visit was measured. Finally analysis of association between some selected independent variables with the outcome variable was done using logistic regression model at 95% CI and p 2). Paired T-test revealed that there was a statistically significant difference between mean of body mass index at admission and at the 3rd visit. Good ready-to-use therapeutic food treatment adherence (AOR 11.145;95% CI 6.556, 18.946), moderate acute malnutrition at admission (AOR 6.71;95% CI 2.618, 17.195), good ART adherence (AOR 2.136;95% CI, 1.269, 3.595) and being male (AOR 1.73;95% CI 1.052, 2.850) have a statistically significant contribution for body mass index improvement. The study identifies factors that determine gain in body mass index among AIDS patients on ready-to-use therapeutic food. However, although the study revealed a statistically significant difference between body mass index during enrolment, and after three months, we disagreed with the right and left utilization of imported food because of lack of sustainability, and aid dependency. We rather recommend interventions that encourage households to produce food with similar outcomes from locally available food staff.

Seroprevalence of Hepatitis B Virus (HBV) among Voluntary Healthy Blood Donors at Tellewonyan Memorial Hospital Voinjama, Lofa County, Liberia

Background: The prevalence of transfusion associated hepatitis B virus (HBV) infection differs across different population geographically. Ascertaining the seroprevalence of HBV infection is vital to informing the way of precautionary and control strategies. This study sought to establish the seroprevalence of hepatitis B surface antigen (HBVsAg) among blood donors in Yelewonyan Memorial Hospital Lofa, Liberia. Methods: This was a retrospective study which involved reviewing of blood donation records for the year 2020 at Telewonyan Memorial Hospital in Lofa County. The data obtained from the records were analyzed. Data analysis was done using SPSS version 12 for windows. Results: A total of 584 voluntary blood donors were screened for donation in 2020. Out of 584, 554 (95.9%) were males while the rest were females. Prevalence of 3.3% was observed among blood donors in Telewonyan Memorial Hospital. There is a significant difference between gender and age with HBV seropositivity among blood donors. Conclusion: The findings of this study suggest that the study site is of low endemicity with HBV infection. Usually, males are more probably to be HBVsAg seropositive than their female’s counterpart. Planning more extensive study and educational programs would help minimize the spread of HBV infection among the general population.

Effectiveness and Safety of 9-Month Treatment Regimen for Multidrug-Resistant Tuberculosis in the Philippines

Background: The Philippines has a burden of drug-resistant tuberculosis (DR-TB). One of the key challenges in the programmatic management of DR-TB (PMDT) is the high rate of loss to follow-up (38% in the 2010 cohort). An urgent need for a shorter, more tolerable, less expensive treatment regimen exists. The aim of the operational study is to determine the efficacy and safety of the short treatment regimen among drug resistant TB. Methods: This is a prospective single-arm cohort study evaluating the effectiveness and safety of a shorter 9 - 11-month treatment regimen (9MTR) for rifampicin-resistant/multi-drug resistant TB (RR/MDR-TB) in 10 PMDT facilities. All eligible consenting adult patients with rifampicin-resistant TB were enrolled and received the standardized 9-month treatment regimen (9MTR), including injectables, with a follow-up after 12 months of treatment completion. Results: A total of 329 patients were enrolled from July 2015 to December 2016. At the 6th month post-enrollment, 256 (77.8%) of them had culture-negative test results. The end-of-treatment success rate was 74.1% (224 [68.0%] were cured and 20 [6.1%] completed the treatment). On the other hand, 10 (3.0%) died, 41 (12.5%) lost to follow-up, 33 (10.0%) withdrawn, 1 (0.3%) treatment failure. In the 12th month after 9MTR completion, among the 244 patients with successful treatment, 198 (81.1%) had culture-negative results, while there were 46 patients whose culture tests were not done. One patient developed TB relapse with fluoroquinolone resistance. The majority of the adverse events were mild that occurred mostly during the first 6 months of treatment. Conclusion: The 9-month treatment regimen had a high treatment success rate with a favorable safety profile. The loss to follow-up was reduced;however, it was still a challenge. The introduction of the 9MTR via operational research had a major impact on building national capacity and infrastructure for the programmatic adoption of a new regimen. Ten PMDT centers received training and experience, created diagnostic pathways, and active drug safety monitoring and management were built.

Analysis of determinants of gross margin income generated through fishing activity to rural households around Lake Ziway and Langano in Ethiopia

This article analyzed determinants of gross margin income from fishing to the rural households around Lake Ziway and Langano in Ethiopia. Four districts adjacent to the two lakes were selected purposively from which 179 respondents drawn randomly. Both primary and secondary information comprises of household structure and assets, climate factors and supportive services were organized. Data analysis employed descriptive statistics, budgetary analysis and the Ricardian method. Budgetary analysis showed positive fish gross margin income (GMI) of ETB 3,023.40 to average fisher. The Ricardian analysis made use of the climate only model (Model 1) and comprehensive model (Model 2). Using Model 1, water level raise due to inflow is vital to earn fair income in addition to the rainfall amount in Season 1, which is supported with positive impact of precipitation water level interaction on fish income. Impact of precipitation was positive in Season 3, due to meher rainfall and withdrawal of fishing labor to join agriculture that minimized over fishing. Using Model 2, precipitation water level interaction has positive impact in Season 2 due to better inflow and Meher rainfall. The interaction term was negative in Season 4 attributed to decreased water level, dry weather and less precipitation. The result also showed positive impact of household members participation, participation in the traditional financial arrangement and capacity to finance operating costs. The study highlights problems facing fishing business like: decreased lake size and water volume, lake turbidity and siltation, open access and weak institutional arrangement to guide fishing efforts, wetland farming and expansion of irrigation to the lake side, cost of fishing materials, minimum sales price as well as poor access to the fish market. Hence, strengthening fishery coperatives, awareness creation, off-farm opportunities, integrated conservation works, reduced wetland farming and acquaintance to social networks were suggested.

Using UNAIDS’s organizing framework to assess Nigeria’s national HIV monitoring and evaluation system

The Nigeria National Response Management Information System (NNRIMS), developed in 2004 as a framework for monitoring and evaluating the country’s response to HIV, does not function at an optimum level due to several challenges, including a confusing proliferation of vertical reporting systems, competition among sectors, and the nascent nature of the monitoring and evaluation (M&E) sub-systems within many institutions. An assessment of the existing M&E system was conducted to verify whether the system has the capacities to provide essential data for monitoring the epidemic and identifying critical programming gaps. Nigeria’s National Agency for the Control of AIDS (NACA) used an organizing framework for a national HIV M&E system developed by UNAIDS, to assess the strengths and weaknesses of the NNRIMS to generate data for evidence-based decisionmaking. The participatory approach used during an assessment workshop ensured that the process was country-led and -owned to build consensus and local capacity, and that it encouraged adoption of a single national-level multisectoral HIV M&E system. The assessment found an operable M&E system at the national level but a much weaker system at the state and local levels and across seven other sectors. There are multiple data collection and reporting tools at the facility level that lead to vertical reporting systems, which increases the burden of reporting at lower levels, especially by service providers. Human resources are being developed, but problems remain with the quantity and quality of staff. Data use, though evident at the national level, is still very weak among five of the seven sectors assessed. The assessment results have been used to develop a national costed M&E workplan to which all stakeholders contributed in a coordinated response to strengthen the system.

Adaptation of Smallholder Dairy Farmers in South Western Kenya to the Effects of Climate Change

Despite great potential, Kenyan smallholder dairying faces diminishing land sizes, high input costs, poor extension contacts, non-responsive price policies, and new pests and diseases. Climate change will worsen the situation. This study sought to assess smallholder dairy farmers’ climate change adaptation level in Southwestern Kenya. Adopting Concurrent Fixed Mixed Methods, primary and secondary data was collected. Reports and papers were reviewed for temperature and precipitation data, dairy population, production trends, and farmers’ socio-demographics. A survey questionnaire for climate changes and farmers’ adaptiveness was administered to 367 smallholder dairy household heads with 10 years’ experience, obtained by multi-stage sampling from 4 sub-counties. Key informant interviews (KIIs) and focus group discussions (FGDs) were conducted with farmer groups, heads of research, government departments and livestock farms;and the old that were obtained purposively based on dairying experience. Percentages were used for climate change effect on smallholder dairying and farmers’ adaptation. Principal component analysis was used for factors with great influence on respondents’ climate change adaptiveness;while one proportion Z-score test was used for significant differences between adapters and non-adapters (p < 0.05). Flexible and systematic Framework Approach was used for qualitative data analysis by cases and 5 themes. Findings indicated that despite Migori County’s great dairying potential, climate changes have partly hindered full exploitation. Temperatures and rainfall increased slightly in 30 years;with feeds and water diminishing, and resistant diseases and parasites emerging. Upon ranking, pasture loss (42.2%);over-grazing (41.1%);cattle under-feeding (39.5%);and increasing cattle diseases and pests (61.0%) had high impact;while drying water sources (37.1%) had moderate effect. Farmers’ adaptiveness included mixed farming (96.5%);non-intensive dairying (95.1%);establishing own fodder (92.4%);rearing crossbred dairy cattle (87.7%);reducing dairy herd size to 2 (92.9%);relying mainly on household labour (94.6%);and maintaining a 10-year increasing trend in milk-income (68.4%). Z-scores indicated significant differences between adapters and non-adopters (p < 0.05). Civil societies, academic and research institutions should intensify farmer advisory services to complement government extension.

Obstetrical Surgery in the Context of Ebola Virus Disease (Ebola) in Guinea: Lessons Learned from 2 Cases

In this manuscript, the authors have studied obstetrical surgery in the context of Ebola virus disease in Guinea. No protocol recommends childbirth outside of Ebola treatment center, although it has no technical platform and no qualified providers in this area. These were unknown MVE cases in pregnant women/parturient women aged 25 and 40 years, with no education, who were confirmed in the RT-PCR test after surgical management. To fight Ebola virus transmission, traditional protection protocols must be strengthened. Training, supervision and monitoring of providers are key elements for the protection of staff in the event of an EVD outbreak. Improving working conditions and strengthening hand washing, usage of PPE/EPP, decontamination of equipment with 0.5% chlorine solution, hygiene of premises, immunization of personnel involved, are effective measures to combat EVD.

Field Durability of Yorkool^(█) LN Nets in the Benin Republic

Context: Recent publications on WHO recommended methods for estimating the survival of LLINs are good guidelines for assessing the performance of long-lasting insecticidal nets (LLINs). Thus, this field trial study was undertaken to evaluate the durability of the Yorkool? LN mosquito net distributed during the 2017 campaign in Benin. Methods: The monitoring of Yorkool? LN nets was carried out in two districts (Djougou III and Barienou) in Djougou, department of Donga, northern Benin from October 2017 to March 2019. A representative sample of 250 households that had received the Yorkool? LN polyester LLINs during the 2017 campaign was selected in the rural and urban areas of each district and monitored for 6, 12 and 18 months. An evaluation of the survival of Yorkool? LN nets was conducted based on the rate of loss and physical condition of the surviving nets as measured by the proportional hole index (pHI). Finally, the chemical efficacy of these LLINs during each period was determined using the WHO cone tests. Results: Survival of Yorkool? LN nets was similar in both rural and urban areas, although there was a difference in survival between the 6-month (95.3%), 12-month (89.7%), and 18-month follow-up periods (74.4%). A difference in survival was also observed between the NetCalc model (84%) compared to the Yorkool? LN nets of this study (74.4%). The attrition rate was 29.6% for LLINs at 18 months. Surprisingly, the physical integrity of the LLINs was minimally affected in the municipality. Indeed, the proportion of mosquito nets in good condition without a hole was 51.8% compared to 56.8% with a hole after 18 months. Only 7.8% of the LLINs in the two districts were damaged compared to 2.6% which needed to be replaced. The washing frequency, location of the LLINs and the frequency of use are some factors contributing to the appearance of the holes in LLINs. The bio-efficacy results of LLINs based on the cone test were good with mortality rates of 74%, 66%, 72% and 58% respectively after baseline, 6, 12 and 18 months of use. Conclusions: The observed differences in the survival of Yorkool? LN nets are due to community living conditions and movements and not to the equipment used to manufacture LLINs. However, the estimated median survival has shown that Yorkool? LN nets would have an average lifespan of 2 years 8 months despite their fairly good physical condition. These results may be useful to the National Malaria Control Program (NMCP) during the period of replacement of these nets on the field.

A multi-purpose National Forest Inventory in Bangladesh:design,operationalisation and key results

Background:National forest inventory and forest monitoring systems are more important than ever considering continued global degradation of trees and forests.These systems are especially important in a country like Bangladesh,which is characterised by a large population density,climate change vulnerability and dependence on natural resources.With the aim of supporting the Government’s actions towards sustainable forest management through reliable information,the Bangladesh Forest Inventory(BFI)was designed and implemented through three components:biophysical inventory,socio-economic survey and remote sensing-based land cover mapping.This article documents the approach undertaken by the Forest Department under the Ministry of Environment,Forests and Climate Change to establish the BFI as a multipurpose,efficient,accurate and replicable national forest assessment.The design,operationalization and some key results of the process are presented.Methods:The BFI takes advantage of the latest and most well-accepted technological and methodological approaches.Importantly,it was designed through a collaborative process which drew from the experience and knowledge of multiple national and international entities.Overall,1781 field plots were visited,6400 households were surveyed,and a national land cover map for the year 2015 was produced.Innovative technological enhancements include a semi-automated segmentation approach for developing the wall-to-wall land cover map,an object-based national land characterisation system,consistent estimates between sample-based and mapped land cover areas,use of mobile apps for tree species identification and data collection,and use of differential global positioning system for referencing plot centres.Results:Seven criteria,and multiple associated indicators,were developed for monitoring progress towards sustainable forest management goals,informing management decisions,and national and international reporting needs.A wide range of biophysical and socioeconomic data were collected,and in some cases integrated,for estimating the indicators.Conclusions:The BFI is a new information source tool for helping guide Bangladesh towards a sustainable future.Reliable information on the status of tree and forest resources,as well as land use,empowers evidence-based decision making across multiple stakeholders and at different levels for protecting natural resources.The integrated socioeconomic data collected provides information about the interactions between people and their tree and forest resources,and the valuation of ecosystem services.The BFI is designed to be a permanent assessment of these resources,and future data collection will enable monitoring of trends against the current baseline.However,additional institutional support as well as continuation of collaboration among national partners is crucial for sustaining the BFI process in future.

Historic Cities: Issues of Urban Conservation, edited by Jeff Cody and Francesco Siravo. Getty Conservation Institute, Los Angeles, 2019. 610 pp. $60.00. ISBN9781606065938

Jeff Cody and Francesco Siravo have captured the crisis confronting historic cities and issued a call to action in Historic Cities:Issues of Urban Conservation.The book consolidates thinking about,investigations into and ac-tions taken that embarks us on a journey to educate us about and rescue historic cities for the value they repre-sent to us now and into the future.The world is now URBAN and as much as the Development Set still ro-manticizes rural development at the expense of urban areas,it is cities—all sizes and kinds of cities—that are the future.

From potential to practice: how accelerating access to HPV tests and screen and treat programmes can help eliminate cervical cancer

Human papillomavirus(HPV)vaccination campaigns to prevent cervical cancer are being considered and implemented in countries around the world.While vaccination will protect future generations,it will not help the millions of women currently infected,leading to an estimated 311000 deaths per year globally.This paper examines a selection of strategies that when applied to both existing and new technologies,could accelerate access to HPV testing.Authors from the US Agency for International Development,the National Institutes of Health,and the Bridge to Health Medical and Dental,a non-governmental organisation,joined forces to propose a scalable and country-directed solution for preventing cervical cancer using an end-to end approach.Collectively,the authors offer seven evidence-based strategies,that when used alone or in combination have the ability to reduce HPV-caused cervical cancer deaths and disability.These strategies include(1)consistent HPV test intervals to decrease HPV DNA test costs;(2)exploring market shaping opportunities;(3)employing iterative user research methodologies like human-centred design;(4)target product profiles for new HPV tests;(5)encouraging innovation around cervical cancer screen and treat programmes;(6)developing national cancer control plans;and(7)integrating cervical cancer screen and treat services into existing infrastructure.By using the strategies outlined here,in combination with HPV vaccination campaigns,national governments will be able to scale and expand cervical cancer screening programmes and provide evidence-based treatment programmes for HPV-infected women.

A One Health approach to fight antimicrobial resistance in Uganda: Implementation experience, results, and lessons learned

Uganda has been implementing the Global Health Security Agenda(GHSA)since 2015 to build its capacity according to World Health Organization(WHO)Benchmarks on International Health Regulations Capacities.The country remains prone to outbreaks,with more than 2o disease outbreaks reported in the past five years,including Ebola virus disease,Crimean-Congo haemorrhagic fever,Marburg haemorrhagic fever,measles,yel-low fever,coronavirus disease 2019(COVID-19),and cholera.Antimicrobial resistance(AMR)is an ongoing challenge.Uganda scored capacity level 3 on infection prevention and control(IPC)and antimicrobial steward-ship(AMS)in the 2017 Joint External Evaluation(JEE)assessment.Identified gaps were being addressed after a self-assessment in 2021.This paper describes the technical assistance approaches provided to Uganda by the Medicines,Technologies,and Pharmaceutical Services Program,funded by the United States(U.S.)Agency for International Development,and implemented by Management Sciences for Health.The program,through a One Health approach,supported systematic capacity strengthening based on the JEE's capacity advancement framework for global health security,specifically relating to AMR.The program's interventions impacted 32 WHO benchmark actions(7 for AMR multisectoral coordination,16 for IPC,and 9 for AMS),contributing to Uganda's strengthened GHSA capacity.Leveraging success built on the AMR platform,the program trained 745 health workers in IPC for the Ebola virus and provided support for simulation exercises by eight district IPC teams.The program also worked with the Ministry of Health to coordinate IPC for the COVID-19 response in five health regions,covering 45 districts and reaching 5,452 health workers at 858 health facilities.2024 Chinese Medical Association Publishing House.Published by Elsevier BV.