General
Govt called upon to Fund Research in NCDs: Diabetes can be Prevented and Effectively Managed
“Non-communicable diseases (NCDs) are a rapidly growing health burden in Uganda, and many other low and middle income countries. I call upon the Government of Uganda to fund research in NCDs. Most people with NCDs do not know that they are suffering from NCDs such as diabetes, high blood pressure, cancer, or heart diseases. For diabetes, about half of the people with diabetes in Uganda do not know that they have it,” said Prof. Rhoda Wanyenze, Dean of Makerere University School of Public Health.
According to the World Health Organisation (WHO) report of 2016, deaths from NCDs were on the rise, with developing countries hit hardest. NCDs are the leading cause of death globally. In 2016, they caused 71% of all deaths (40.5 million) up from 60% in 2000.
Opening the SMART2D Research Dissemination Workshop to various stakeholders held on 21st March 2019, Prof. Wanyenze applauded researchers from Makerere University School of Public Health for teaming up with other partners to undertake a multi-country four year research project aimed at identifying strategies to better prevent and manage Type-2-Diabetes, one of the NCDs.
She commended the research team headed by the Uganda co-Principal Investigator, Prof. David Guwatudde for not only describing problems, but also providing prevention and management strategies for Type-2-Diabetes.
The co-Principal Investigator of SMART2D, Prof. David Guwatudde emphasized that the primary aim of the four year research was to strengthen capacity for both prevention and management of Type-2-Diabetes.
“Health systems in most parts of the world were struggling to diagnose and manage Type-2-Diabetes especially in low and middle income countries. More than 50% of people with diabetes in Uganda are undiagnosed. They are not aware that they have diabetes. Further in Uganda, only about 30% of people with diabetes have ever had their blood tested for high blood sugar,” he said.
Funded by the European Union (EU) and Government of Sweden through the Swedish International Development Cooperation Agency (Sida), the SMART2D research presents a people-centered approach through Self-Management and Reciprocal Learning for the Prevention and Management of Type-2-Diabetes.
Prof. Guwatudde revealed that Type-2-Diabetes is more of a lifestyle disease, which can be prevented if we modify our lifestyle and behaviour. The nutrition aspect is one of the factors leading people to get diabetes.
According to Dr. Juliet Kiguli, co-Investigator on the SMART2D, some of the factors putting one at the risk of getting diabetes included: consumption of unhealthy foods (eating sweet things, too much oil, alcohol); physical inactivity (not exercising); Worrying; and ignoring the advice from medical personnel.
With Dr. Elizabeth Ekirapa sharing statistics that diabetes wields a tremendous economic burden on society (to patients and the economy at large); and further revelation from Dr. Roy William Mayega that most of the patients the research team interviewed, could not afford the drugs and equipment to monitor their blood sugar, yet often there are stock-outs of these at Government health centers. He emphasized that SMART2D advocates for strategies aimed at prevention and effective management of diabetes. “Prevention is better than cure. Since diabetes can be prevented and the prevalence of pre-diabetes is high, preventive efforts should be stepped up so as to save lives as well as resources that are going to be spent on treatment.”
For those living with diabetes, Prof. David Guwatudde emphasized that if they follow the advice of the medical personnel and take the prescribed medicines; they can live a normal life. “It is not true that when they diagnose you with diabetes you die soon. If you take the prescribed medicines and follow the advice from medical personnel, you will live with diabetes and still live a normal life.”
The SMART2D research team consists of the following researchers: Prof. David Guwatudde, Dr. Juliet Kiguli, Dr. Roy William Mayega, Dr. Barbara Kirunda Tabusibwa, Dr. Elizabeth Ekirapa Kiracho, Dr. Francis Xavier Kasujja, Dr. Anthony Muyingo, Mrs. Max Walusimbi, Ms. Gloria Naggayi, Mr. Edward Ikoona, and Mr. Kusolo Ronald.
Some of the challenges in the prevention and management of NCDs include: Inadequate prevention strategies; a large proportion of people with NCDs are undiagnosed; lack of funds to buy the recommended medicines; and poor retention into care.
To address the four challenges, the SMART2D research team came up with a set of Facility and Community interventions.
Minimal improvements in organization of facility-based care significantly improved the percentage of patients with diabetes that are retained into care by over 30%. It also improved control of the disease in the patients by over 10%, and prevented the development of diabetes among people at high risk by over 50%.
In line with WHO report published in 2002 titled Innovative Care for Chronic Conditions: Building Blocks for Action which noted that a community has a crucial role to play in chronic care, Dr. Francis Xavier Kasujja reiterated that peer groups were instrumental in the ongoing support to diabetes patients in Iganga and Mayuge communities.
Delivering a personal testimony, one of the patients with diabetes said that they significantly benefited from the engagement and trainings received during the SMART2D project.
However, with the end of the project, most of the patients were worried because they cannot afford the cost of treatment for management of diabetes.
Presenting the implications of their findings on policy, Dr. Roy William Mayega highlighted the following recommendations:
• Health Centres from level III+ should be supported to establish diabetes care and prevention services and accredited in a phased way
• Roll-out of a minimum package of equipment, and essential drugs from Health Centre III and above, supported by a regular supply, inclusive of hypertension medicines
• Need to roll out lean clinical guidelines and a care algorithm to all facilities
• Scaled training (pre- and -in-service), supervision and clinical mentorship of nurses and clinical staff on care and prevention
• Strengthen the information system for chronic care including appointments, clinical records and follow-up
• A simple health education and coaching approach and manuals should be rolled out to facilities targeting patients and people at high risk
• A task shifting approach should be scaled up where stable patients are managed by nurses
• Need to strengthen self-care so that patients can manage themselves
Representing the Ministry of Health, Dr. Gerald Mutungi the Senior Medical Officer in Charge on Non-Communicable Diseases shared with workshop participants some of the strategies being undertaken: The Ministry of Health has a technical working group on NCDs; ongoing research aimed at studying the effectiveness of the integration of HIV/AIDS and NCDs into the chronic care clinic; and Government entering into a strategic partnership with Novartis, an NCD drugs manufacturer, to ensure that drugs for NCDs are available at all Government health facilities.
Some of the key stakeholders who attended the SMART2D Research Dissemination workshop include: Dr. Gity Behravan,1st Secretary and Senior Research Advisor, Swedish Embassy- Kampala, Dr. Fred Makumbi-Deputy Dean of Mak School of Public Health, Dr. Esther Buregyeya, Dr. Noah Kiwanuka and officials from the World Health Organisation, Ministry of Health, NCD platforms, diabetic associations, lung and heart institutions, district health workers, patients from Iganga and Mayuge, Makerere University Directorate of Research and Graduate Training, and among others.
Written by: Ritah Namisango, Mak Public Relations Office
The degree of attentiveness was at its peak in the Yusuf Lule Central Teaching Facility (CTF) Auditorium as Ms. Janet Nabukeera addressed support staff during a Safeguarding and Inclusion training. Her words were firm, direct and reflective. Ms. Nabukeera, the Deputy Human Resource Officer in charge of Performance and Payroll, emphasized that a negative attitude in the workplace creates a toxic environment where colleagues feel hesitant to collaborate or share ideas.
“Avoid unnecessary confrontations with colleagues because jealousy and anger destroy more than they build. When you hold grudges at work, you slowly burden your own heart and mind. Stress can take a toll on your health and productivity. Safeguard yourself by choosing peace, love yourself first and extend that same grace and respect to others.” Ms Nabukeera, cautioned.
The training attracted over 300 Support Staff Members, including Security Personnel, Cleaners, Hall Attendants, Administrative Assistants, Librarians, and Laboratory Support Teams from across the University.
In his remarks, Dr. Rodney Rugyema, the Acting Principal Warden, urged staff to have a positive attitude towards their jobs and encouraged them to ensure that students, fellow staff and visitor’s feel safe, respected and protected.
“You are the eyes and ears of the University, while you may not deliver lectures, you are often the first to notice when something is wrong. So you have to promote an environment free from bullying, discrimination, neglect and intimidation. You have to ensure secure hostels, well-lit walkways, functioning locks and safe laboratory environments,” Dr Rugyema, said.
Makerere University has a duty of care to do no harm and promote the wellbeing of all students, staff, and other University community stakeholders. It seeks to enhance the learning environment to make it more secure, inclusive, and ethically sound for all stakeholders.
The Makerere University Safeguarding Policy lays out the University’s framework for embedding viable safeguarding measures into its ethos and all institutional activities and processes to: Identify, detect, and swiftly act on safeguarding risks; prevent the occurrence of harm; provide mechanisms for reporting all allegations or incidents that have occurred; respond appropriately to all reported incidences; and, continuously monitor, evaluate and learn from practices and experiences of managing safeguarding concerns.
“Safeguarding is not only for lecturers or University Management, it is everyone’s responsibility, If you have someone mistreating you, or you come across any risk, do not suffer in silence report through the MakSafeSpace,” Dr Rugyema, said.
The MakSafeSpace is the e-reporting platform complimenting the other University traditional reporting channels. It is an inclusive platform that provides for confidential modes of reporting safeguarding risks and incidences.
As the session concluded, there was a renewed understanding among participants that safeguarding is a collective duty. From the security guard at the gate to the cleaner in the Hall of Residence, it was clear that every staff member contributes to creating a safe and respectful learning environment.
To involve and create opportunities for students and staff members with disabilities, Light for the World Uganda trained the support staff to become inclusion champions.
Mr. Musa Mwambu, the Disability Inclusion Advisor at Light for the World Uganda, called upon staff to remove barriers limiting the full participation of students and colleagues with disabilities, in line with the UN Convention on the Rights of Persons with Disabilities.
“Just like any other person, people with disabilities have the right to education, health, and protection. Society has the duty to remove barriers that block participation. When barriers are removed, disability no longer limits opportunity,” Mr. Mwambu noted.
Drawing from his own lived experience as a person with a disability, he shared how access to the right support systems enables him to communicate effectively and perform daily tasks.
“It is about putting the right conditions in place to participate fully in society. We need multi-stakeholder collaboration to remove barriers and achieve an inclusive society,” he said.
Justine Namuddu, the Support Staff representative on the Makerere University Council, thanked the organizers for the insightful workshop. She reminded fellow staff that Makerere University is a home for everyone and urged them to take care of it.
“Fellow members, as you carry out your duties, ensure that you observe both emotional and intellectual safety. Before sharing information, first verify whether it is true. Safety is being at peace with yourself and with others,” Namuddu emphasized.
She also encouraged younger staff members to take advantage of educational opportunities provided by the University, noting that those who wish to continue with their studies may apply for tuition waivers.
The training concluded with reminders on professionalism and accountability. Staff were encouraged to consistently use the Biometric Attendance Management System to capture attendance accurately. With biometric clock-in devices installed at reception areas across the Main and Satellite campuses, the Directorate of Human Resources can monitor attendance in real time, while staff can keep track of hours worked.
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