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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

Health

MU-JHU Position: Training & Development Coordinator

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Participants in the two-day MU-JHU hybrid meeting discuss the upcoming IMPOWER-022 study, the HPTN 084 DSMB results and the changing landscape of HIV Prevention studies in Uganda, April 2021.

The Makerere University-Johns Hopkins (MU-JHU) Research Collaboration – MU-JHU CARE LTD, a Kampala – based equal opportunities Clinical Research and Service Delivery Organisation with more than 350 employees is seeking interested, committed and reliable professionals with the described qualifications to apply for the position of Training & Development Coordinator.

Training & Development Coordinator – 1 position Description and purpose:

The successful candidate has overall responsibility to plan and administer programs to ensure that employees have the skills and knowledge to compete effectively and meet the organization’s business objectives including direct training as well as support to content specialist trainers. The successful candidate will be responsible to liaise with middle management to identify training needs and support talent retention and development strategies with senior management.

Required qualifications and profile:

The successful candidate will be an experienced professional with hands on experience coordinating training and development programs in a large corporate setting, preferably in a similar health and/or research environment. The ideal candidate must possess a minimum of Bachelor’s degree in Education, Training, with a post graduate degree in HRM or a Bachelor’s degree in Human Resources Management. A relevant Masters level degree is desirable. The candidate should have proven ability to complete the full training cycle (assess needs, plan, develop, coordinate, monitor and evaluate) and experience with e-learning platforms and direct adult training and train the trainer methods, including on-the-job coaching and mentorship programs. The ideal candidate must have a minimum of 3 years’ experience working as a HR practitioner. Experience working in a health related research organization will be an advantage. The candidate should be MS Office proficient in MS Office packages. The ideal candidate should possess advanced organizational skills with the ability to handle multiple assignments and strong written and oral communication skills as well as emotional intelligence.

The holder of this position will work under the supervision of the Human Resources Manager and will be responsible for the following duties:

1. Develop a robust training policy and related procedures for the organization

  • Conduct organization-wide training needs assessment and identify skills or knowledge gaps that need to be addressed
  • Mapping out training plans and schedules, designing and developing training programs (outsourced or in-house)
  •  Source for training opportunities to enhance staff performance including advanced training for individuals and participation in grant writing for training/capacity development grants
  •  Assess training effectiveness and determine the impact of training on employee skills and KPIs Maintain an updated training database
  •  Ensure planning, monitoring, and appraisal of employee work results by training managers to coach employees.

2.  Support the HR team carry out HR operational requirements.

Applications with complete C.Vs, including 3 referees and their full addresses or contact Tel No.’s, copies of academic certificates and testimonials, should be hand delivered to: The Human Resources Manager, through reception Room 10, located in MUJHU 1 Building or sent by email (application should not exceed 15MBs) to hroffice@mujhu.org – not later than 30th April, 2021 by 5:30p.m. Only short listed applicants will be contacted.

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World Health Day 2021 – Op-Ed by H.E. Veestraeten & Prof. Wanyenze

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The Dean, Makerere University School of Public Health (MakSPH)-Prof. Rhoda Wanyenze addresses participants at the EVAWG Bazaar on 6th December 2018, ResilientAfrica Network (RAN) Innovation Lab, Plot 30, Upper Kololo Terrace, Kampala, Uganda

As we mark World Health Day 2021, the Ambassador of Belgium to Uganda, H.E. Rudi Veestraeten and the Dean, School of Public Health, Prof. Rhoda Wanyenze co-authored an Op-Ed in line with the theme; Health Equity, a fairer and healthier world.

“Health is critical and especially now, with COVID-19 so World Health Day should receive more attention” remarked Prof. Wanyenze.

Please click the link below to access the full Op-Ed

https://uganda.diplomatie.belgium.be/sites/default/files/content/download/files/world_health_day_2021_op-ed.pdf

The same has been published on Page 18 of the New Vision, Wednesday, April 7, 2021 under the Comments & Letters Section

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Mak Unveils C-19: COVID-19 Mobile Contact Tracing App

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Project Principal Investigator, MakSPH's Dr. Harriet Babikako (2nd R), the Department of Pediatrics and Child Health's Dr. Ezekiel Musasizi (1st R) and Dr. Ezekiel Mupere (1st L) and Mr. Haron Gichuhi (2nd L) after the application launch at Child and Family Foundation Uganda Offices, Kampala.

By Joseph Odoi

As government strives to reduce community spread of the novel coronavirus, Makerere University researchers have developed a mobile application that digitizes the investigation, case, and contact tracing for COVID-19 in communities.

With Funding from Makerere University Research and Innovations Fund (MakRIF) and Partnership from Child and Family Foundation Uganda and Ministry of Health, the application is designed to investigate case and contact tracing for COVID-19, timely reporting and decision making to improve the efficiency of COVID-19 response and capture community feedback.

While launching  the application under project titled ‘’C-19’’, Dr. Harriet Babikako  the Project lead  said her team was inspired by the need to  address the existing challenges of trekking long distances for hours to ascertain information in regards to suspected or even confirmed cases of COVID-19, delayed communication and  responses, loss of contact lists and transcription errors .

“Currently, Community surveillance teams have to trek distances for hours to go and find information from suspected or even confirmed cases. Therefore, challenges such as incomplete identification of contacts, delays in communication, and response, loss of contact lists, inadequate data collection, and transcription errors exist, making the system slow, and inefficient. Thus information exchange between involved parties is too slow and expensive because, by the time a response is generated, the disease is spreading. This means the spreading of COVID-19 is not solved efficiently” she explained in a zoom session on Tuesday 30th March 2021.

Dr. Harriet Babikako-the Project lead delivers her remarks at the Application launch.

As part of the features, the application has various COVID-19 self-assessment components on its Epi -COVID Tracer Dashboard. This enables the app user to undergo self-screening or screen others using different prompts.

The application also boasts of support services that include COVID-19 Laboratories and hospitals all authorized by Ministry of Health. One can consult Private Doctors and Counsellors on the App through WhatsApp or other call options.

In terms of reservation, the application system enables one to book for a COVID-19 test from the nearest authorized laboratories .This is done by filling a lab booking form which locates the test center near you.    Additionally, it also enables different user’s right from Community, VHTs District Task Force DTF and National Task Force NFT by filling the contact tracing form.

An interface of the C-19 Mobile Contact Tracing App

On the relevance of the app to School going students, Haron Gichuhi a health informant and Co-Investigator of the project; said this mobile application empowers health workers within schools to appropriately screen students and allows them to manage/refer probable cases of COVID-19.

“Now that schools are open, School nurses can use the application to carry out tests and refer students to nearest laboratories with in their proximity.

“The application also gives the students their COVID-19 status and advises them on preventive methods like self-isolation” noted Dr. Gichuhi of the ambitious innovation which took 6 months to create

On cost effectiveness, the researchers say the app addresses the concept of high costs to government. This is because the application is available to communities like market vendors, schools, individuals.

On uniqueness of the mobile innovation, the researchers cited decision making, quick scanning of information, case management and peer checking for other colleagues as special qualities ingrained in the application.

With this app, one can  book a COVID-19 test with MOH authorized Laboratories and hospitals on the application and also  consult a private doctor or a private counsellor. This can be done within any citizen’s comfort with just a click on their phone.

Mr. Ezekiel Musasizi from Department of Pediatrics and Child Health, Makerere University, (Co-investigator) says the team is in the process of translating the app to different languages to cater for all classes of society

In her final remarks, Dr. Harriet Babikako thanked Ministry of Health, Partnership from Child and Family Foundation Uganda and the Government of Uganda efforts towards supporting research and innovation through Makerere University Research and Innovations Fund (MakRIF). The launch attracted virtual participants from academia, non-government organizations, students, development partners, the media and Ministry of Health.

MORE ABOUT PROJECT TEAM

The C-19 Project was implemented by researchers and innovators from Makerere University with funding from Makerere University Research and Innovations Fund (MakRIF).

The Project /innovation team includes; Dr. Harriet Babikako from Makerere University School of Public Health (Principal Investigator), Dr. Vincent Michael Kiberu (Co-Pi) and Dr. Ezekiel Mupere (Co-Pi) from Department of Pediatrics and Child Health and Mr. Haron Gichuhi (Co-PI and Health Informant).

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