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PubMed2002

Mental illness in one district of Uganda.

AIMS: To estimate the prevalence of psychiatric disorder in one district of Uganda. METHODS: Data were collected from a survey of a random sample of households in Kabarole, West Uganda. Interviews were carried out with household members. Further information was obtained from interviews of key community informants and from Focus Group discussions conducted in each Parish. RESULTS: Some 384 households were surveyed. Of these, 99 households identified members with a mental illness in the previous year and a total of 130 individuals were identified, 12 of whom were children. Few individuals had been seen by formal mental health services and traditional methods of treatment were commonly used. CONCLUSIONS: The estimated prevalence of 30.7% in adults is higher than that of 25.3% found in the only other community based survey of mental illness previously conducted in Uganda. A well conducted study using modern case defining methods needs to be carried out in Uganda.

Adolescent↗
PubMed2026

The Re-Emergence of Bundibugyo Ebolavirus in Uganda and the Democratic Republic of Congo: Epidemiological Drivers, Response Strategies, and Implications for Global Health Security.

Bundibugyo ebolavirus (BDBV) is one of the least studied species within the genus Orthoebolavirus (family Filoviridae), despite its capacity to cause severe Ebola virus disease (EVD) with substantial mortality. First identified during a 2007-2008 outbreak in Bundibugyo District, western Uganda (149 reported cases, 37 deaths; case-fatality rate [CFR] approximately 25-36%), BDBV re-emerged in 2012 in Orientale Province, Democratic Republic of the Congo (DRC) (57-59 cases, 29-34 deaths; CFR 34-58%), before resurfacing in Ituri Province, DRC, in April-May 2026. By 11 August 2026, this third outbreak had grown to 4566 laboratory-confirmed cases and 2128 deaths (CFR ≈ 47%) across five DRC provinces and Uganda, becoming the largest, fastest-growing BDBV epidemic on record and the second-largest Ebola-family outbreak overall. This narrative review, not a systematic review or meta-analysis, summarizes peer-reviewed literature, preprints, and official situation reports from WHO, Africa CDC, US CDC, ECDC, and national health ministries, identified through PubMed, Scopus, Web of Science, Google Scholar, and Embase from inception to 12 August 2026, to examine BDBV historical evolution, virology and pathogenesis, drivers of re-emergence, surveillance and response, therapeutic and vaccine gaps, and global health security implications. The 2026 outbreak, unfolding amid conflict and mass displacement in eastern DRC, has been marked by an estimated basic reproduction number of 1.4-2.1 (central estimate 1.71), disproportionate infection among healthcare workers (7.2% of confirmed cases in DRC, 20% in Uganda), and the continued absence of licensed BDBV-specific vaccines or therapeutics. Findings underscore the need for sustained genomic and ecological surveillance, decentralized rapid diagnostics, broadly protective pan-filovirus vaccines, conflict-sensitive response strategies, and strengthened Uganda-DRC collaboration. Because the evidence base for the ongoing outbreak remains preliminary, findings should be interpreted cautiously and revisited as further peer-reviewed data emerge.

Bundibugyo ebolavirus↗
PubMed2004

Reanalyzing the 1900-1920 sleeping sickness epidemic in Uganda.

Sleeping sickness has long been a major public health problem in Uganda. From 1900 to 1920, more than 250,000 people died in an epidemic that affected the southern part of the country, particularly the Busoga region. The epidemic has traditionally been ascribed to Trypanosoma brucei gambiense, a parasite now confined to central and western Africa. The Busoga region still reports sleeping sickness, although it is caused by T.b. rhodesiense, commonly believed to have spread to Uganda from Zambia in the 1940s. Our analysis of clinical data recorded in the early 1900s shows that the clinical course of sleeping sickness cases during the 1900-1920 epidemic in Uganda was markedly different from T.b. gambiense cases, but similar to T.b. rhodesiense. These findings suggest that T.b. rhodesiense was present in Uganda and contributed to the epidemic. The historic context is reassessed in the light of these data.

Adolescent↗
PubMed2000

Determination of drug susceptibility and DNA fingerprint patterns of clinical isolates of Mycobacterium tuberculosis from Kampala, Uganda.

OBJECTIVE: To ascertain the rate of initial drug resistance and transmission patterns of Mycobacterium tuberculosis in Kampala, Uganda. SETTING: National Tuberculosis (TB) Treatment Centre, Mulago Hospital, Kampala, Uganda and Case Western Reserve University, Cleveland, Ohio, USA and McClellan Memorial Veterans Hospital, Little Rock, Arkansas, USA. METHODS: Using a radiometric BACTEC 460 TB system, susceptibility of 215 M. tuberculosis isolates from previously untreated patients from Kampala, Uganda (age range, 17-48 years, mean, 28 years; 56% males and 69% human immunodeficiency virus (HIV)-seropositive) was determined for isoniazid, rifampin, streptomycin and ethambutol. Isolates from 73 patients, selected on the basis of geographical location, were tested for strain diversity or relatedness using the IS6110 DNA fingerprinting technique. RESULTS: Resistance rates were as follows: isoniazid, 7.9% streptomycin, 6.1% rifampin, 1.4% and ethambutol 0.9%. Twelve per cent of the strains were resistant to at least one of the first line drugs tested and 4.7% were multiply resistant. There were no significant differences in resistance rates between patients with and without HIV infection. Using the number and size of DNA fragments containing IS6110, only three clusters of isolates with identical RFLP patterns were found out of the 73 isolates tested (8.2%). Each cluster contained two isolates. Three (4.1%) isolates had less than seven copies of IS6110. CONCLUSION: This study shows that in Uganda initial drug resistance rates to anti-tuberculosis agents are low and similar to other sub-Saharan African countries and that multiple strains of M. tuberculosis have been transmitted within the community.

AIDS-Related Opportunistic Infections↗
PubMed2002

Monitoring the severity of iodine deficiency disorders in Uganda.

BACKGROUND: Iodine deficiency disorders (IDD) cover a variety of pathological conditions including goitre, mental retardation and perinatal mortality in millions of individuals globally. IDD was initially identified as a problem in 1970 and was confirmed in 1991. In 1993, the Uganda government introduced a policy of Universal Salt Iodization (USI) requiring all household salt to be iodized. After 5 years this study evaluates the USI programme. OBJECTIVES: To determine goitre prevalence rate, establish the proportion of household consuming iodized salt and determine the levels of iodine intake in the sample districts. METHODS: A sample of 2880 school children aged 6-12 years from 72 Primary schools in 6 districts of Uganda was studied in October 1999. Goitre was established by palpation, salt iodine was analysed by thiosulphate titration, while urinary iodine was analyzed using ICCIDD recommended method F in which iodine is detected colorimetrically at 410 nm. RESULTS: The over all total goitre rate was 60.2% down from 74.3 in 1991 and visible goitre was 30% down from 39.2% in 1991. The proportion of households taking adequately iodized salt was 63.8% and the median urinary iodine was 310 microg/L. Whereas 36% of 95 urine samples analysed in 1991 had urinary iodine below 50 microg/L, only 5% of the 293 urine samples studied in 1999 had the same urine levels. This represents a considerable improvement in iodine intake, which is confirmed by the fact that 63.8% of the study households consume adequately iodized salt. If maintained and evenly spread, this will enable Uganda to control IDD. CONCLUSION: USI has improved iodine intake in Uganda. However, iodine malnutrition is still a severe public health problem because some communities in this study such as in Kisoro still have low iodine consumption, while others such as Luwero now have iodine excess. The latter is likely to predispose to hyperthyroidism. RECOMMENDATION: The national set standard of household salt iodine of 100 ppm be revised. Locally produced salt be iodized, and a national iodine monitoring programme be instituted to ensure evenly spread consumption of adequately iodized salt by all communities in the country.

Child↗
PubMed2003

Ocular manifestations in paediatric HIV/AIDS patients in Mulago Hospital, Uganda.

BACKGROUND: In Uganda the prevalence of HIV averages 12% as was reported to the STD/AIDS control surveillance unit. In Uganda there are approximately 30,000 HIV infected infants per year. The burden of HIV disease is high in Uganda and patients present with ocular complications. However, there is paucity of information and knowledge concerning ocular manifestations in the paediatric HIV/AIDS population and how they may differ from those of adults. OBJECTIVES: To describe the ocular manifestations of HIV/AIDS infection in an African paediatric population. Generally the study will record the external ocular manifestations seen but specifically to document the intra-ocular lesions, in particular the retinal changes associated with paediatric HIV/AIDS. DESIGN: A cross-sectional hospital based study. SETTING: The study was conducted at the Paediatric Infectious Disease Clinic at Upper Mulago Hospital, in Kampala, Uganda. PATIENTS: Patients are those with positive HIV sero status, with or without symptoms and signs of AIDS. Parents/caretakers of the children were interviewed to obtain the socio-demographic data of the patients and a general physical as well as an ophthalmic examination were conducted to document any ocular problems. RESULTS: A total of 158 HIV -infected children were examined. The overall rate of ophthalmic involvement was 35%. The most common finding was a non-purulent conjuctivitis, observed in 12% of the patients, followed by perivasculitis of the peripheral retinal vessels, in 12% of patients and molluscum contagiosum.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Has the HIV/AIDS epidemic changed sexual behaviour of high risk groups in Uganda?

BACKGROUND: Uganda, was the first country in sub-Saharan Africa to reverse its HIV/AIDS epidemic. Long distance drivers, prostitutes and barmaids have been identified as the groups that engage in risky sex, which promotes HIV transmission in Uganda and other countries across the continent. This paper investigates whether and why there were changes of sexual behaviour and practices among five risky groups in Uganda as a consequence of HIV/AIDS epidemic. METHODOLOGY: The paper is based on data generated from a survey on 'resistance to sexual behaviour change in the African AIDS epidemic', which was conducted in the districts of Kabale, Kampala and Lira in 1999. For purposes of this paper, only data from the focus group discussions with high-risk groups have been analysed. These include commercial sex workers, street children, long haul truck drivers, bar maids and adolescents in three towns of Uganda (Kabale, Kampala, Lira). RESULTS: Results indicate that despite the HIV/AIDS epidemic, these groups had only changed their sexual behaviour a little, and they reported to be continuing with multiple sexual partners for a variety of reasons. The adolescents and street children were under peer pressure and a lot of sexual urge; commercial sex workers and bar maids attributed their risky behaviour to the need to survive due to the existing poverty; and the truck drivers reflected on the need for female company to reduce their stress while on the long lonely travels across Africa. Nevertheless, they are all aware and perceive people with multiple sexual partners as being highly vulnerable to contracting HIV and they all reported to have adopted condom use as an HIV preventive strategy. They also observed that married people were at a high risk of contracting HIV due to non-use of condoms in marital relationships and unfaithfulness of spouses. CONCLUSIONS Females engage in high-risk sexual relations as a means of economic survival, and perceive their acts as a strategy to improve their socio-economic well being. On the contrary, men in these high-risk categories do such acts out of pleasure and as avenues for attaining fulfilled sexual lives. The search for money among women and the constant desire for men to have sexual pleasure, which are greatly facilitated by their financial status are the forces behind reckless sexual behaviour among high-risk groups.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Outcome of different nevirapine administration strategies in preventing mother-to-child transmission (PMTCT) programs in Tanzania and Uganda.

OBJECTIVE: Prevention-of-mother-to-child transmission (PMTCT) interventions based on single-dose nevirapine (NVP) are widely implemented in Africa, but strategies differ regarding how and when to administer the drug to women and infants. The aim of this study was to analyze the outcome of different strategies with regard to NVP intake in pregnant women and their infants in Tanzania and Uganda. METHODS: In an observational study carried out between March 2002 and December 2004, we compared a directly observed NVP administration strategy in Tanzania (supervised NVP intake for women and infants at a health unit) and a semi-observed administration strategy (self-administered NVP for women at home and supervised intake for infants at a health unit) in Uganda. RESULTS: The proportions of HIV-positive women accepting receipt of NVP from the health units were similar in the 2 countries (42.4% in Tanzania vs 45.6% in Uganda; P = .06). NVP intake in infants was significantly higher in Tanzania than in Uganda (43.7% vs 24.1%; P > .001). In a multivariate analysis, maternal age above 25 years, secondary education, Catholic faith, and having undergone PMTCT counseling at a hospital were independently associated with infant NVP intake. CONCLUSION: In our settings, the directly observed administration strategy resulted in a higher NVP intake in infants. The semi-observed strategy, which implies that, after home delivery, the infant has to be presented to a health unit for NVP administration, was less successful.

Adult↗
PubMed2000

Cellular immunity to human immunodeficiency virus type 1 (HIV-1) clades: relevance to HIV-1 vaccine trials in Uganda.

The first prophylactic human immunodeficiency virus type 1 (HIV-1) vaccine trial in Africa, with a clade B immunogen, is currently under way in Uganda, in a region where clades A and D are endemic. The use of a B clade vaccine is based on anticipated cross-recognition of endemic strains of HIV-1 in Uganda, but, in fact, little is known about the cytotoxic T lymphocyte (CTL) responses in that region. Seventeen HIV-1-infected volunteers from Kampala, Uganda, were studied to determine the immune responses elicited by natural infection with local HIV-1 strains. Despite the presence of broad cross-clade recognition, the CTL responses to the infecting viral clade were highest in most people. Recognition of nonendemic clade B antigens was similar to that of the coendemic local clade, and, in some instances, cross-recognition of clade B was greater. Nevertheless, the degree of cross-clade cellular responses we observed lends justification to the use of clade B-based immunogens in the current phase 1 vaccine trial in Uganda.

AIDS Vaccines↗
PubMed2001

A case-control study of human immunodeficiency virus infection and cancer in adults and children residing in Kampala, Uganda.

Uganda offers a unique setting in which to study the effect of human immunodeficiency virus-1 (HIV-1) on cancer. HIV-1 is prevalent there, and cancers which are known to be HIV-associated, such as Kaposi's sarcoma and Burkitt's lymphoma, are endemic. Adults residing in Kampala, Uganda, presenting with cancer in city hospitals were interviewed and had an HIV test. Of the 302 adults recruited, 190 had cancers with a potentially infectious aetiology (cases). The remaining 112 adults with tumours not known to have an infectious aetiology formed the control group. In addition, 318 children who were also Kampala residents were recruited and tested for HIV: 128 with cancer (cases) and 190 with non-malignant conditions (controls). HIV seroprevalence was 24% in adult controls and 6% in childhood controls. The odds of HIV seropositivity among cases with specific cancers (other than Kaposi's sarcoma in adults) were compared with that among controls, using odds ratios (ORs), estimated with unconditional logistic regression. All ORs were adjusted for age (<5, 5-14, 15-19, 30-44, 45+) and sex and, in adults, also for the number of lifetime sexual partners (1 or 2, 3-9, 10+). In adults, HIV infection was associated with a significantly (p < 0.05) increased risk of non-Hodgkin's lymphoma [OR = 6.2, 95% confidence interval (CI) 1.9-19.9, based on 21 cases] and conjunctival squamous-cell carcinoma (OR = 10.9, 95% CI 3.1-37.7, based on 22 cases) but not with cancer at other common sites, including liver and uterine cervix. In children, HIV infection was associated with a significantly increased risk of Kaposi's sarcoma (OR = 94.9, 95% CI 28.5-315.3, based on 36 cases) and Burkitt's lymphoma (OR = 7.5, 95% CI 2.8-20.1, based on 33 cases) but not with other cancers. The pattern of HIV-associated cancers in Uganda is broadly similar to that described elsewhere, but the relative frequency of specific cancers, such as conjunctival carcinoma, in HIV-infected people differs.

Adolescent↗
PubMed2026

Emergence of a Bundibugyo virus variant in the 2026 outbreak in the Democratic Republic of the Congo and Uganda.

In May 2026, an outbreak of Ebola disease caused by Bundibugyo virus (BDBV, species Orthoebolavirus bundibugyoense) was declared in the Democratic Republic of the Congo (DRC), with cases originating from DRC and locally transmitted cases reported in Uganda. Bundibugyo virus disease (BVD) outbreaks were previously recorded in 2007-2008 in Bundibugyo District, Uganda, and in 2012 in Isiro, DRC. Here, we generated 22 genomes from samples obtained from individuals with BVD in DRC and Uganda. These genomes form a well-supported phylogenetic cluster separate from BDBV variants associated with the 2007 and 2012 outbreaks, together with evidence for sustained human transmission. This is consistent with the emergence of a new zoonotic spillover event rather than resurgence from previously reported variants. Besides ongoing efforts in strengthening surveillance systems, community engagement, establishing Ebola treatment centers, and developing targeted medical countermeasures; our report advocates to specifically increase decentralized laboratory diagnostics capacity, with pan-Orthoebolavirus assays, including genomic sequencing capacity, for limiting further outbreak expansion, timely detection and control of future outbreaks.

Journal Article↗
PubMed2006

Improved efficacy with amodiaquine instead of chloroquine in sulfadoxine/pyrimethamine combination treatment of falciparum malaria in Uganda: experience with fixed-dose formulation.

Amodiaquine (AQ) is an affordable compound, chemically related to chloroquine (CQ) but often effective against CQ resistant Plasmodium falciparum. In Uganda, a pre-packed fixed-dose combination of CQ plus sulfadoxine/pyrimethamine (CQ+SP) called Homapak is used in the home based management of fever program (HBM). We performed a single blind randomized trial to determine the efficacy of AQ+SP in comparison with the fixed-dose CQ+SP (Homapak) in the treatment of uncomplicated falciparum malaria in Ugandan children aged 6 months to 5 years. The study was done in 2004 at Walkuba Health Center, a sub-urban area in Jinja district, Uganda. Primary outcome was the day 14 per protocol clinical and parasitological response according to the WHO. A total of 183 children were included (mean age 28 months) and 90% completed 28 days of follow up. The day 14 adequate clinical and parasitological response was 70.9% for CQ+SP and 97.4% for AQ+SP (p<0.001). In those given CQ+SP, treatment failure rates for the 6 months to 2 years age group were much higher (48.2%) than in the older children (18.2%, p=0.004). The day 28 PCR adjusted parasitological failure rates were also higher in the CQ+SP (31.3%) than in the AQ+SP group (13.1%) (p=0.003), with a higher gametocyte carriage among the CQ+SP group. We conclude that the efficacy of AQ+SP was significantly superior to the fixed-dose CQ+SP (Homapak), particularly among the youngest children. Thus, AQ could be used instead of CQ in combination with SP to improve the effectiveness against falciparum malaria in Uganda.

Amodiaquine↗
PubMed2004

Uganda AIDS prevention: A,B,C and politics.

Uganda is one of the few countries in the world that has experienced a significant reduction in Human Immunodeficiency Virus (HIV) prevalence over the past decade. In contrast to many of its neighbors, Uganda has had an explicit national policy that includes: Abstinence, Be faithful, and Condoms. This strategy, known as "A,B,C," has garnered wide attention in the United States as the efficacy of abstinence-based sex education is debated. This commentary is based on published and unpublished data together with personal observations derived from a Department of Health and Human Services (DHHS)-led delegation to Uganda in December 2002. The empirical bases for both an abstinence-only and a combined (A,B,C) strategy is reviewed; and the political consequences of the debate for both Africa and the United States are explored.

Adolescent↗
PubMed2004

The political environment of HIV: lessons from a comparison of Uganda and South Africa.

Considerable interest has arisen in the role of governance or political commitment in determining the success or failure of HIV/AIDS policies in sub-Saharan Africa. During the 1990s, Uganda and South Africa both faced dramatic HIV/AIDS epidemics and also saw transformations to new political systems. However, their responses to the disease differed in many ways. This paper compares and contrasts the ways in which policy environments, particularly government structures, can impede or expedite implementation of effective HIV prevention. Four elements of these environments are discussed--the role of political leadership, the existing bureaucratic system, the health care infrastructure, and the roles assigned to non-state actors. Two common international strategies for HIV prevention, syndromic management of sexually transmitted infections and sexual behaviour change interventions, are examined in relation to these elements in Uganda and South Africa during the mid-to-late 1990s. During this period, Uganda's political system succeeded in promoting behaviour change interventions, while South Africa was more successful in syndromic management efforts. Interactions between the four elements of the policy environment were found to be conducive to such results. These elements are relatively static features of the socio-political environments, so lessons can be drawn for current HIV/AIDS policy, both in these two countries and for a wider audience addressing the epidemic.

Cross-Cultural Comparison↗
PubMed2005

Psychological distress among AIDS orphans in rural Uganda.

More than 11 million children under 15 years in sub-Saharan Africa have lost at least one parent to AIDS. In Uganda, about 2 million children are orphans, with one or both parents dead. The objective of this study was to investigate the psychosocial consequences of AIDS orphanhood in a rural district in Uganda and to identify potential areas for future interventions. The study was conducted in a randomly selected sub-county in Bushenyi District in Uganda. The study population consisted of 123 children aged 11-15 years whose parents (one or both) were reported to have died from AIDS and 110 children of similar age and gender living in intact households in the same neighbourhood. Symptoms of psychological distress were assessed using the Beck Youth Inventories of Emotional and Social Impairment (BYI). The standardized interview also included questions concerning current and past living conditions. A multivariate analysis of factors with possible relevance for BYI outcome showed that orphan status was the only significant outcome predictor. Orphans had greater risk (vs. non-orphans) for higher levels of anxiety (odds ratios (OR)=6.4), depression (OR=6.6), and anger (OR=5.1). Furthermore, orphans had significantly higher scores than non-orphans on individual items in the Beck Youth Depression Inventory that are regarded as particularly "sensitive" to the possible presence of a depressive disorder, i.e. vegetative symptoms, feelings of hopelessness, and suicidal ideation. High levels of psychological distress found in AIDS orphans suggest that material support alone is not sufficient for these children.

Acquired Immunodeficiency Syndrome↗
PubMed2005

"When the obvious brother is not there": political and cultural contexts of the orphan challenge in northern Uganda.

It is estimated that two million of Uganda's children today are orphaned primarily due to AIDS. While recognising the immense impact of HIV/AIDS on the present orphan problem, this article calls for a broader historic and cultural contextualisation to reach an understanding of the vastness of the orphan challenge. The study on which the article is based was carried out among the Langi in Lira District, northern Uganda, with a prime focus on the situation of orphans within the extended family system. The data were collected through ethnographic fieldwork (8 months); in-depth interviews with community leaders (21), heads of households (45) and orphans (35); through focus group discussions (5) with adult men and women caring for orphans, community leaders and with orphans; and also through documentary review. A survey was conducted in 402 households. The findings reveal a transition over the past 30 years from a situation dominated by 'purposeful' voluntary exchange of non-orphaned children to one dominated by 'crisis fostering' of orphans. Sixty-three percent of the households caring for orphans were found to be no longer headed by resourceful paternal kin in a manner deemed culturally appropriate by the patrilineal Langi society, but rather by marginalised widows, grandmothers or other single women receiving little support from the paternal clan. This transition is partly linked to an abrupt discontinuation of the Langi 'widow inheritance' (laku) practice. It is argued that the consequential transformations in fostering practices in northern Uganda must be historically situated through a focus on the effects of armed conflicts and uprooting of the local pastoral and cotton-based economy, which have occurred since the late 1970s. These processes jointly produced dramatic economic marginalisation with highly disturbing consequences for orphans and their caretakers.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Applied and basic research on the epidemiology, morbidity, and immunology of schistosomiasis in fishing communities on Lake Albert, Uganda.

We report multidisciplinary studies on schistosomiasis which have been ongoing in the fishing communities of Piida, Booma, Bugoigo and Walakuba, on Lake Albert, Uganda, since 1996. Schistosomiasis is the major health problem in this area, with high infection intensities and prevalence. In addition to generating basic data on the epidemiology, morbidity and immunology of human schistosomiasis, this research programme is providing important descriptive and methodological information, and has contributed to the increase in operational capacity within Uganda in recent years. Such information and operational capacity are needed to facilitate much needed schistosomiasis control programmes, such as the Schistosomiasis Control Initiative that was launched in Uganda in 2003.

Animals↗
PubMed2004

Banana streak virus is very diverse in Uganda.

Banana streak virus (BSV) is a badnavirus that causes a viral leaf streak disease of banana and plantain (Musa spp.). Identified in essentially all Musa growing areas of the world, it has a deleterious effect on the productivity of infected plants as well as being a major constraint to Musa breeding programmes and germplasm dissemination. Banana is a staple food in Uganda which is, per capita, one of the worlds largest banana producers and consumers. BSV was isolated from infected plants sampled across the Ugandan Musa growing area and the isolates were analysed using molecular and serological techniques. These analyses showed that BSV is very highly variable in Uganda. They suggest that the variability is, in part, due to a series of introductions of banana into Uganda, each with a different complement of infecting viruses.

Badnavirus↗