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Interventions to Increase Compliance Levels Around COVID-19 In Refugee Communities

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By Joseph Odoi

Uganda’s open-door policy on refugee-hosting has been internationally acclaimed as “the world’s most compassionate”. And while Uganda is among the world’s top three refugee-hosting nations, possibly the first in Africa, refugee communities continue to be disadvantaged on many fronts with poor socioeconomic and health outcomes.

Refugee settings are already besieged with a socially disrupted existence, and the COVID-19 experience could have catastrophic consequences in their context. Yet the extent to which refugee communities are aware of Covid-19, have complied, and are coping with the related preventive measures, remains largely unknown.

Moved mainly by three issues: 1) Uganda’s open-door policy on refugee hosting; 2) COVID-19; and 3) the knowledge gap on COVID-19 impact in refugee communities,  Makerere University researchers in partnership with different institutions in academia, policy and practice have commenced on a study contributing to increased compliance with the Ministry of Health’s Covid-19 prevention guidelines under the project  entitled “Refugee Lived Experiences, Compliance, and Thinking” (REFLECT) in Covid-19.

According to Dr. Gloria Seruwagi, the Principal Investigator, study findings will contribute to filling gaps in knowledge, policy by designing programmes to increase understanding and compliance levels around COVID-19 and refugee communities:

“Little is known about how refugee communities have complied with the Ministry’s guidelines like social distancing, wearing masks, sanitizing or frequent washing of hands with soap. Yet it is widely known that their living arrangements in crowded spaces with massive WASH (Water, Sanitation and Hygiene) challenges have been a long-standing challenge, even before the Covid-19 pandemic. To address this knowledge gap the Ministry of Health has partnered (as a Co-Investigator) with our study team which also comprises other Co-Investigators from Gulu University, ACORD and Lutheran World Federation which are implementing partners in refugee settlements.” explained Dr. Seruwagi

‘’This mixed methods research has a sample size of ~1,500 participants evenly distributed across three study sites in Central, West Nile and South Western refugee settlements. Similarly, there was fairly even distribution across nationalities with Congolese (30%), Somalis (33%) and South Sudanese (33%). Overall, the majority of participants were aged between 25-34 years (35%), of female gender (68%), of Moslem (30%) or Protestant (36%) religious denomination, uneducated (40%) and earned less than UGX 50,000 weekly (57%). In addition, the overwhelming majority neither smoked (97%) nor drunk alcohol (92%).  Except for age and gender, there were variations in demographic and behavioral characteristics across the three study sites’’ she added.

Preliminary Findings

As part of preliminary findings from the study, Dr Seruwagi noted that there are very high levels of awareness about COVID-19 among the majority of the adult population. However, there are variations in this knowledge across refugee settings, with urban refugees being more knowledgeable on average than their rural counterparts. However, in reverse they [urban refugees] also displayed and reported higher risk behaviour in regards to Covid-19 than their rural-based counterparts who showed relatively more compliance. Despite being more knowledgeable than women with regard to symptoms, causes, risk factors, and treatment of COVID-19, men have poor compliance with Covid-19 preventive measures compared to women.

Children ages 5-12 were found to have very low levels of knowledge, explained by the assumption that adults at home will always pass on information and so, no targeted information is being given to children. “Due to school closure, teachers who are key change agents and transmit information were not in contact with the children. We believe this is a missed opportunity greatly contributing to these low knowledge levels among children”  Dr. Gloria explained while sharing findings at Makerere University (CTF1 Building). In addition to disenfranchisement around access to Covid-related knowledge, school closure further heightened children’s vulnerability with a marked increase in neglect, exposure to different forms of violence and teenage pregnancy.

On attitudes, Dr. Seruwagi noted that previous adverse experiences like war, torture, rape or hunger  have produced a “survivor” mentality with little or no fear  among respondents in refugee communities.  One  refugee said “I have dodged bullets, been tortured and slept hungry for days, what more harm can Covid do to me?”

On adherence to preventive guidelines, Presidential directives and SOPs, handwashing was the most commonly adhered to guideline, again among the adults.  Local leaders had come up with innovative mechanisms for ensuring compliance through supervision; and  most households had washing points at the peak of COVID-19. ‘’Handwashing was even much higher in Muslim communities, mostly because it is in tandem with their religious and sociocultural practices’’ Dr. Seruwagi explained.

On masks, the researchers noted that there was not so much compliance in wearing masks, reportedly after restrictions were eased. There was a lot of “chin-masking” with those who had  just wearing them on chins but without using them to cover up. Some other risky behaviours were observed such as borrowing masks at places where it was mandatory (health facilities, offices) or when they saw authorities and enforcers coming.

On social distancing: the researchers noted that local leaders have tried to enforce this at public meeting spaces; but it’s almost impossible at household level due to large family sizes. Also, sociocultural norms require them to sit together, eat together (including from the same utensils) which makes it almost impractical.

Despite the challenges, the researchers observed that there are also stories of resilience, innovation and improvisation among refugee communities. Local leaders made arrangements to help their people including translating prevention messages into local languages, having strict rules e.g. for social distancing at water collection points and enforcing handwashing facilities at household level. They also internally arranged some relief items. And new businesses (e.g. mask production) were birthed out of COVID-19. Key support systems during Covid-19 were reported to be health facilities, WASH, community leaders including religious leaders and the diaspora.

On the way forward, the research team highlighted the need for innovation and  designing age-appropriate messages and interventions for children, incorporating mainstream COVID-19 messaging in all teacher-learner interactions, building on community resilience and leadership, continuous communication and impact messaging with heavy focus on risk reduction.

In his presentation entitled; REFLECT study implications for policy, Mr. Brian Luswata the Principal Legal Officer from Ministry of Health (MOH) reported that MOH is conducting an integrated Covid-19 response to the entire public regardless of nationality. He indicated that available data shows that over 151 refugees countrywide have contacted Covid-19 and 3 deaths have been registered. He further revealed that MoH conducts regular trainings of health workers in refugee settlements and quarantine facilities have been created to counter any spread of the pandemic. He noted the timeliness and importance of this study, saying it will directly feed into policy and guidelines on the prevention of COVID-19 and other similar pandemics.

Mr. Brian Luswata the Principal Legal Officer from Ministry of Health (MOH) making a presentation at the event.

Representing the Dean, Makerere University School of Public Health, Dr. Elizabeth Ekirapa commended the REFLECT study team led by Dr. Seruwagi noting that the study will shed more light on how to deal with issues like human behaviour during the Covid-19 pandemic.

“When COVID-19 started people were saying nobody is dying and now people have started to die. Human beings keep coming up with explanations in a manner that you wouldn’t expect. So this study will help us learn on how we can deal with ourselves’’ said Dr. Ekirapa who is also Chair of the Department of Health Policy Planning and Management at MakSPH.

She further appreciated the REFLECT study’s multisectoral approach adding that the findings will contribute to changes in the different multisectoral approaches Uganda is using to address COVID-19.

Dr. Elizabeth Ekirapa commended the REFLECT study team led by Dr. Gloria in her remarks

In her remarks, Prof. Josephine Ahikire,  the Principal of the College of Humanities and Social Sciences (CHUSS) said that the role of Makerere University is to create knowledge that will be used for societal development and transformation.

She equally thanked Government of Uganda for continuous support to Makerere University through the Research and Innovation Fund (Mak-RIF) which also has a provision for research on COVID-19. She congratulated the researchers for the timely study which underscores the academia role in social work, humanity and public health. She also thanked the partners for supporting the initiative.

Prof. Josephine Ahikire – the Principal College of Humanities and Social Sciences (CHUSS) giving her remarks at the event

Jesse Kamstra,  the Country Representative for Lutheran World Federation (LWF) commended Uganda’s effort in the fight against Covid-19.

“I feel safer in Uganda than any other country due to the different adaptations they have taken up to make this disease less spread in the country’’  said  Kamstra.

As implementing partners in the study, he mentioned that LWF expects actionable recommendations and evidence-based understanding of social behaviours of refugees during COVID-19. He further noted that the recommendations will be used to adjust future programming together with other implementing partners like Office of the Prime Minister (OPM)’s refugee department.

Jesse Kamstra the Country Representative Lutheran World Federation (LWF) at the event commended Uganda for fighting Covid-19 at the REFLECT STUDY launch

Ms Ellen Bajenja Kajura the Country Director for ACORD, also one of the study partners, expressed her pride at the partnership with Makerere and the other partners. Even from preliminary findings, she talked about some of the immediate actions her organisation will begin taking forward like designing child-friendly messages on Covid-19 in addition to strengthening ACORD’s programming in child protection and gender-based violence.

At the event, Dr. Misaki Wayengera, Chairman of Scientific Advisory Committee (SAC) on the National Taskforce for COVID-19 revealed  that despite challenges brought by Covid-19,  total reopening of various sectors will go on.

‘’We started opening up but some sectors remain closed because we are still studying transmission dynamics, however we shall continue opening up because we will have to live with COVID-19’’ he explained.

Dr. Misaki Wayengera, Chairman of Scientific Advisory Committee (SAC) on the National Taskforce for COVID speaking at the REFLECT STUDY launch

Professor Noeline Nakasujja the Adhoc Chair (psychosocial) on the COVID-19 Taskforce and also Head of Psychiatry Department of Makerere University College of Health Sciences noted the significant increase in Mental Health issues and psychiatry referrals during COVID-19. She decried the limited infrastructure or community capacity to handle these. She called on all stakeholders to work together in their different capacity to address mental health and psychosocial support especially for more vulnerable populations like those in refugee settings.

Prof. Noeline Nakasujja speaking at the event

During the event, refuge representatives shared their experiences during pandemic response.

On what makes Uganda one of the best refugee host community, Ms. Lilly Anek a Refugee representative from Adjumani had this to say: ‘’Uganda is the best refugee host country because they treat us like brothers and sisters. This is why we intermarry as South Sudanese and Ugandans… people treat us so well’’ Similarly, other refuge representatives like Sandie from Kyaka II  at the event were in agreement with her statement as they confirmed receiving handwashing detergents, face masks and training on COVID-19 prevention. Together, they called upon government of Uganda to put in a place an additional taskforce in the refuge communities so that new entrants are quarantined before joining the community.

The event was graced by officials from Office of the Prime Minister (OPM) which manages the national refugee response, UNHCR, representatives from the ministry of health, Makerere University, civil society, the media and other stakeholders. Discussions during this dialogue centered around the growing numbers of challenges during Covid-19, perceptions and nomenclature, infrastructural limits in refugee hosting communities and adaptations to the new normal in this Pandemic era.

Dr Julius Kasozi representing UNHCR assured the study team that UNHCR is more than ready to take forward  and implement any actionable recommendations from the REFLECT study. In his  closing remarks as government representative, Mr. Byaruhanga of OPM said there was a lot to learn  and adapt from the study. He encouraged the study team to engage further with his office to ensure ownership  and uptake of the study findings.

More about the REFLECT Study

The research topic is “Knowledge, adherence and the lived experiences of refugees in COVID-19: A comparative assessment of urban and rural refugee settings in Uganda”. The project has been shorted to the acronym REFLECT (Refugee Lived Experiences, Compliance, and Thinking).

The study is  cross-sectional mixed  and  has a multinational focus covering refugees from South Sudan, Somalia, and Eritrea, Democratic Republic of Congo (DRC), Rwanda, and Burundi.  Similarly, Study sites are Kisenyi in Kampala, Kyaka II Refugee Settlement in Kyegegwa, South-Western Uganda, and eleven (11) refugee settlements in West Nile.

The REFLECT study is funded by the UK government through Elrha/Research for Health in Humanitarian Crises (R2HC) supported by Wellcome Trust, UKAID and National Institutes for Health Research (NIHR). It is conducted by Makerere University with Dr. Gloria Seruwagi as Principal Investigator. The Co-Investigators are from Gulu University, Agency for Cooperation and Research in Development (ACORD), Lutheran World Federation (LWF), the National Association of Social Workers of Uganda (NASWU) and Ministry of Health. The study team includes Dr Gloria Kimuli Seruwagi, Dr. Denis Muhangi, Dr. Betty Okot, Prof. Stephen Lawoko, Eng. Dunstan Ddamulira, Andrew Masaba and Brian Luswata.

Article originally posted on MakSPH

Mark Wamai

Health

MakSPH METS 2024 Annual Report

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Cover image of the MakSPH METS 2024 Annual Report featuring The U.S. Ambassador to Uganda, H.E. William W. Popp, Minister of Health, Hon. Dr. Jane Ruth Aceng and other officials. Photo: METS. Makerere University School of Public Health (MakSPH), Monitoring and Evaluation Technical Support (METS) Program, Kampala Uganda, East Africa.

I am pleased to present our annual report. Throughout the past year, MakSPH-METS Program has remained steadfast in its mission to strengthen Uganda’s capacity for HIV and TB programming through strengthening robust health information systems, surveillance, and quality improvement initiatives.

MakSPH leverages its team of expertise in public health to guide program strategies, strengthen national capacity for data collection, analysis, and use. The innovations developed are solutions for health system challenges and they generate evidence that can be used to inform policy and practice.

MakSPH-METS provides technical support to MoH, RRHs, implementing partners at different health system levels.

Our collaborative approach, working closely with the Government of Uganda and various stakeholders, has enabled us to make significant strides in building sustainable health information systems and improvingthe quality of healthcare delivery. The achievements highlighted in this report reflect our commitment to strengthen health systems through development and implementation of innovative and impactful evidence- based solutions.

As we look to the future, I am confident that the METS Program will continue to play a pivotal role in strengthening Uganda’s health systems through several initiatives.

  1. Operationalising a sustainability plan through transitioning of the developed innovations to the Ministry of Health for ownership.
  2. Disease outbreak management will be strengthened through continued capacity building for emergency response and optimization of existing integrated disease surveillance systems. The field teams will facilitate seamless coordination across health system levels to build sustainable and resilient health systems capable of effectively responding to public health emergencies.
  3. Lastly, we continue to strengthen collaboration with government, enhance coordination with implementing partners and promoting integration of health services.

Our dedicated team of professionals, combined with the unwavering support from our partners and stakeholders, positions us well to address emerging health challenges and advance our nation’s public health goals. The innovative solutions and capacity-building initiatives highlighted in this report demonstrate not only our progress but also our potential for greater impact in the years ahead.

Professor Rhoda Wanyenze
Dean – School of Publc Health, Makerere University

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KeyScope Project Job Advert: Junior Research Fellow

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Part of the team at the Makerere University Biomedical Engineering Unit under the Department of Physiology, College of Health Sciences (CHS), Kampala Uganda, East Africa.

Background

Makerere University Biomedical Engineering Unit under the Department of Physiology is glad to advertise for positions under its new Project ‘KeyScope Project: The Key to Sustainable Cancer Diagnosis and Treatment in Uganda.”

Laparoscopic surgery is considered as the standard of care for cancer treatment in high-income countries. However, this technology is rarely accessible to LMICs due to the high cost of installment, lack of maintenance personnel, unreliable electricity, and shortage of consumable supplies. To address these concerns, a unique multidisciplinary collaboration between engineers, surgeons, oncologists, and business experts from Duke University, Makerere University, Uganda Cancer Institute and University of Maryland joined efforts to develop a low-cost, durable laparoscopic system (KeySuite) for use in resource- constrained environments.

Our aims are aligned to demonstrating the local capacity to manufacture, acquire local and international regulatory approval, determine clinical performance and distribute/sell the KeyScope to the local market. Specifically, we shall improve the current design and determine the local capacity to manufacture the device, establish the clinical safety and acceptability of the product, and obtain regulatory approval from local and international accredited bodies.

Position: Junior Research Fellow

Reports to: Project Coordinator

Engagement: Full time

Duration: 1 year renewable upon satisfactory performance

Duty Station: Kampala

Roles and responsibilities

As a trainee, a Junior Research Fellow will closely work with a research team to undergo training design, manufacturing and validation of the KeyScope. This is a non-degree/no-credit training opportunity that will prepare the successful candidate for advanced studies and future industry work in an upcoming medical technology sector of Uganda and Africa at large.

Specifically the Fellow will;

  1. Participate in the local construction of the KeyScope through material assessment and selection, developing a product manufacturing plan, and carrying out an impact assessment.
  2. Aid in the establishment of clinical safety and acceptability of the KeyScope through the use of a feasibility study to secure approvals, recruit patients and surgeons.
  3. Contribute to the process of attaining regulatory approval from a certified body for the KeyScope.
  4. Contribute to the development of a commercialization plan under training and mentorship of a Business Developer.
  5. Actively engage in project documentation, questionnaire and ethics protocol development, journal article writing and publication, report writing.
  6. Conduct key informant interviews, administer questionnaires, and verbatim transcription of interview recordings.
  7. Participate in data collection and analysis using digital and paper-based tools.
  8. Participate and contribute to teaching and student mentorship.
  9. Engage with the research partners and stakeholders.
  10. Any other activities as assigned by the Principal Investigator, and Project Coordinator (Immediate Supervisor) from time to time.

Qualifications:

  1. Completed a Bachelor’s Degree in Biomedical Engineering or any closely related field and at least awaiting graduation in not more than 6 months from an accredited University in Uganda.
  2. If completed, candidate must not have graduated more than 1 year ago.
  3. Academic qualifications of having attained or expecting at least expecting a second-class upper division degree.
  4. Experience in Human-Centered Design skills and Design Thinking will be highly considered.
  5. Prior experience in working with international multidisciplinary teams and organizations.
  6. Experience of previous work on laparoscopy is a plus.
  7. Evidence of prior interest for research, design, innovation and medical device manufacturing.
  8. Applicant should have a desire to work with different fabrication techniques.
  9. Ability to multitask and perform duties in learning environment with minimum supervision
  10. Excellent scientific writing skills and a good command of communication skills.

How to Apply:

All suitably qualified and interested candidates should submit a one-page cover letter, one-page writing sample, CV (maximum 3 pages) with relevant certificates, transcripts & two reference letters as a single digitally signed PDF file addressed to the Project PI and emailed to keyscopeu01@gmail.com by 17:00hours on 18th April 2025. Indicate, “KeyScope Project” in the subject line. Those awaiting graduation should send their most recent testimonials. Only shortlisted applicants will be contacted.

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Karolinska’s Department of Global Public Health Admins Visit MakSPH

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Therese Lind, Head of Administration at Karolinska Institutet (KI)’s Department of Global Public Health (3rd Right) with the delegation and staff from MakSPH during the visit on 24th March 2025. Makerere University School of Public Health (MakSPH) hosting delegation from Karolinska Institutet (KI) Department of Global Public Health led by Therese Lind, head of administration for a two-day administrative exchange, part of 25 years of a flourishing partnership, 23rd-24th March 2025, Kampala Uganda, East Africa.

Makerere University School of Public Health (MakSPH) is honored to host a distinguished delegation from Karolinska Institutet (KI) for a two-day administrative exchange, part of our 25 years of a flourishing partnership between Makerere University (Mak) and Karolinska Institutet.

Fostering Administrative Synergies

The visiting team, led by Therese Lind, head of administration at KI’s Department of Global Public Health, comprising HR specialist Sofia Öhlund-Fingal, Sonia Hammi, project manager, Kseniya Hartvigsson, communications officer CESH, and Anna Hansson, project manager, Grants Office—engaged in:

  • Discussions on research administration and financial management
  • Knowledge sharing on operational challenges and best practices
  • Exploring funding opportunities with major donors

The visit covered grants management, procurement, financial systems, and joint application strategies to enhance efficiency and academic exchanges. The team also toured key university facilities, including the historic Main Building, the state-of-the-art MakSPH auditorium, and the construction site, to witness the institution’s growth.

A Legacy of Collaboration

Since 2000, this partnership, Mak-KI, has yielded:

  • 49 PhD graduates through the Sida-supported doctoral program
  • Reciprocal exchanges benefiting 254 students and 153 faculty members
  • ⁣The Centre of Excellence for Sustainable Health, established during the pandemic

This visit reinforces our commitment to strengthening institutional capacity and driving impactful research. We extend our sincere appreciation to the KI team and look forward to continued collaboration.

Davidson Ndyabahika

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