Viola Nilah Nyakato

School re-entry and continuation policies are widely promoted in sub-Saharan Africa (SSA) as a means of safeguarding adolescent mothers’ educational participation, yet their practical effects remain inconsistently documented. With this systematic review we synthesised evidence on national policy and programme responses governing re-entry and continuation for adolescent mothers in SSA, drawing on academic and grey literature published between 2000 and March 2022. Following multi-database searching and screening, 63 sources were included and analysed thematically, guided by African feminism, agency theory, and the positive youth development framework. Across contexts, policy commitments commonly articulate educational rights but fall short at the level of operationalisation: guidance on implementation is often vague, resourcing limited, and accountability mechanisms weak. The evidence shows that re-entry decisions and persistence in school are shaped by intersecting constraints: stigma and moral surveillance, gendered expectations of motherhood, inflexible schooling arrangements, inadequate childcare, and household poverty, alongside uneven school-level interpretation of policy. However, promising practice is visible in alternative and second chance initiatives that combine flexible learning pathways with psychosocial support and childcare or caregiving accommodations, enabling re-engagement and completion where mainstream systems remain exclusionary. Overall, the review indicates that policy expansion has outpaced implementation capacity and social norm change. Advancing adolescent mothers’ educational inclusion requires gender-responsive implementation strategies that translate policy into enforceable procedures, strengthen school and community support structures, and institutionalise cross-sector collaboration to address childcare, stigma, and economic barriers.

African societies have traditionally embraced communal child-rearing, where collective responsibility for children's well-being extends beyond familial ties. This ethos, rooted in the Southern African philosophy of ubuntu and the saying 'it takes a village to raise a child', remains relevant to addressing challenges such as teenage pregnancy, sexual harassment and violence while promoting girls' education. This study, conducted in south-western Uganda from May to June 2022, explored these issues against the backdrop of a surge in teenage pregnancies during COVID-19 lockdowns. It involved 143 participants, including 77 adolescent mothers aged 13-22 years. Betrayal emerged as a central theme in the experiences of teenage mothers, reflected in school dropouts, forced marriages and abandonment. Teenage pregnancy resulted in family tensions, loss of childhood opportunities, and persistent shame and blame. Unmarried adolescent mothers faced entrenched victimisation, perpetuating gender-based violence and limiting aspirations for education and personal growth. Findings underscore the importance of revitalising communal responsibility to address these challenges. Strengthening ubuntu and collective care can mitigate the socio-economic and psychological impacts of teenage pregnancy, support girls' education, and foster gender equity within communities.

While schools in Uganda have sexuality education implementation programs in place, adolescents enrolled in school continue to have considerable concerns about sexuality. This indicates that there is still a gap in the teaching of sexuality education. Understanding, that the pursuit of excellent educational outcomes cannot understate the significance of educators. The objectives of the study were to understand how teachers have influenced the implementation of sexuality education in schools and to understand their influence. We explored their sexuality education teaching experiences. For this study, we purposively sampled 12 teachers from six secondary schools in Mbarara Municipality. These were classroom teachers teaching Biology, Christian Religious education, and Literature, subjects in which topics about sexuality are included. Others were male and female senior teachers in charge of guidance and counselling; and teacher patrons to sexuality learning-related activities outside the classroom. Data was transcribed and analyzed through thematic coding of opinions, feelings, and practices of teachers. Results indicated that the majority of teachers experience discomfort when teaching this subject. To most teachers, this discomfort was attributed to 1. Lack of proper training. 2. Others had strong cultural values and beliefs that made them uncomfortable teaching about sexuality in open places like the classroom. 3. Another minority, were not consulted before being appointed into counselling positions, therefore did not feel obliged to take on the assignment. 5. Lack of instruction materials. 6. Findings also revealed that students are not comfortable learning from their teachers, whom they consider as “second parents” and hence they join and learn more from peers and other adults. 7. While all students, learn about sexuality, only a few teachers are assigned this duty, this has created a teaching burden due to the low teacher-student ratio especially for duties like guidance and counselling and patronising of sexuality education programs. Thus, we deduced that SE was being jeopardised by teachers' inefficacy, attitude, and low teacher-student ratio, and interaction of informal peer educators. We concluded that sexuality education educators, are most effective when they are equipped with skills, their consent to participate is sought, the education does not interfere with their values and when they do not carry an overload of assignments. From the findings, it was also evident that teachers are not the best choice schools should use to guide and counsel students about sexuality. Peers and medical personnel are preferred to teachers. Hence, when the identified gaps are attended to sexuality education will be more efficient to protect and keep skills with adolescents undergoing this education. To improve teacher performance, we recommend that schools assist their teachers in pursuing SE training, seek teachers consent before appointing them into SE educating or counselling positions, support them and offer teaching materials. The low teacher-to-student ratio be resolved by assigning more teacher educators SE roles. Our findings indicate that students feel more at ease studying with their peers than with teachers; hence, we recommended increasing the amount of supervised peer-to-peer SE learning in schools. We also discovered that students value media education, thus we recommend that schools offer more adult-guided media literacy instruction.

Open and positive parent–child communication about sexual and reproductive health (SRH) is known to reduce negative SRH outcomes for young people. However, socio-cultural influences can inhibit meaningful SRH communication. Restrictive gender norms threaten the SRH of adolescents, as they make adolescent boys more likely to engage in risky sexual behavior and make girls more vulnerable to negative SRH outcomes. This study intended to critically understand the impact of gender norms and expectations on parent–child SRH communication in rural south-western Uganda. Methods: The study adopted a community-based participatory approach using community stakeholder engagement meetings (n = 2), in-depth interviews (n = 12), and three focus group discussions with parents (n = 18). The study considered biological parents, step-parents, grandparents, uncles and aunties, as long as they were primary caregivers of adolescents aged 10–14. Results: Participants elaborated on the socio-cultural aspects that shaped their experiences of parent–child SRH communication such as cultural gender norms, religion, and media influences. They also referred to socio-economic challenges, lack of knowledge, and the role of peers and schools. Conclusions: There is need for community-based interventions to improve parent–child SRH communication to address the deeply rooted cultural and gender contexts in rural south-western Uganda.

Purpose Depression is a major contributor to the global burden of disease. The extent to which marital communication may influence depression in contexts with little mental health support is unknown. Methods We conducted a whole-population study of married adult residents of eight villages in a rural region of southwestern Uganda. Depression symptom severity was measured using a modified version of the Hopkins Symptom Checklist for Depression, with > 1.75 classified as a positive screen for probable depression. Respondents were asked to report about ease of marital communication (‘never easy’, ‘easy once in a while’, ‘easy most of the time’ or ‘always easy’). Sex-stratified, multivariable Poisson regression models were fit to estimate the association between depression symptom severity and marital communication. Results Among 492 female and 447 male participants (response rate = 96%), 23 women and 5 men reported communication as ‘never easy’ and 154 women and 72 men reported it as ‘easy once in a while’. Reporting communication as ‘never easy’ was associated with an increased risk of probable depression among women (adjusted relative risk [ARR], 2.06; 95% confidence interval [CI], 1.08–3.93, p = 0.028) and among men (ARR, 7.10; 95% CI 1.70–29.56, p = 0.007). Conclusion In this whole-population study of married adults in rural Uganda, difficulty of marital communication was associated with depression symptom severity. Additional research is needed to assess whether communication training facilitated by local leaders or incorporated into couples-based services might be a novel pathway to address mental health burden.

IMPACT: This research shows that physical intimate partner violence was associated with never testing for HIV while verbal intimate partner violence was associated with increased testing for HIV suggesting that HIV testing interventions should consider intimate partner violence prevention. OBJECTIVES/GOALS: HIV incidence is higher among women who experience intimate partner violence (IPV). However, few studies have assessed the association between HIV testing (regardless of the result) and the experience of IPV. Our objective was to assess the relationship between IPV and HIV testing among women from rural southwestern Uganda. METHODS/STUDY POPULATION: We conducted a whole-population, cross-sectional study including women ?18 years of age who were permanent residents in 8 villages of Rwampara District, southwestern Uganda from 2011-2012 who reported having a primary partner in the past 12 months. We surveyed participants to assess their exposure to 12 different forms of verbal, physical, and/or sexual IPV, and whether they had ever been tested for HIV. We used three separate modified Poisson regression models, clustering by village, to estimate the association between each type of IPV and ever testing for HIV, adjusting for categorical age, completion of more than primary education, and any food insecurity measured by the nine-item Household Food Insecurity Access Scale. RESULTS/ANTICIPATED RESULTS: Among 496 women with a primary partner (>95% response rate), 64 (13%) had never tested for HIV, 297 (60%) reported verbal IPV, 81 (16%) reported physical IPV, and 131 (26%) reported sexual IPV. Further, among these women, 208 (42%) were aged <30 years, 378 (76%) had a primary or no education, and 390 (79%) experienced food insecurity. Never having been tested for HIV was positively associated with physical IPV (adjusted risk ratio (ARR): 1.61, 95% confidence interval (CI): 1.02-2.56) and negatively associated with verbal IPV (ARR: 0.67, 95% CI: 0.44-0.99), but not sexual IPV (ARR: 1.05, 95% CI: 0.51-2.12). DISCUSSION/SIGNIFICANCE OF FINDINGS: Among this population of adult women with partners in Uganda, physical IPV was associated with never testing for HIV while verbal IPV was associated with increased testing for HIV. Evidence suggests that HIV testing interventions should consider IPV prevention, and future studies should focus on why certain IPV types impact HIV testing rates.