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Listening to Population Sentiments is Fundamental for New Vaccines Acceptability

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Public health is concerned with protecting and improving the health of people and their communities by promoting healthy lifestyles, researching disease and injury prevention, detecting, preventing and responding to infectious diseases.

Immunisation as a public health intervention offers a critical opportunity to elevate mother and newborn health on the broader health and development agenda and catalyze progress towards sustainable development. It protects mothers, the developing fetus, and young infants during vulnerable time in their lives.Maternal immunisation not only boosts the mother’s immunity against dangerous pathogens, but a mother’s antibodies can be passed to her unborn baby in-utero through the placenta or through breast milk thereby protecting her and the baby from life-threatening illnesses. For new-born babies, these maternal antibodies provide essential protection during a “window of vulnerability” when infants are too young to get their own immunizations.

There is progress in development and accessibility to life saving vaccines. However, some communities in developed and developing countries still harbour suspicions about such interventions. This mistrust affects proper and timely uptake of new vaccines. Low-and-middle-income countries (LMICs) face challenges of misinformation and negative narratives around safety of vaccines and new medicines. Narratives like Africans are ‘guinea pigs’ for the western world have led to avoidance of life saving interventions. 

Community engagements improve health literacy through collaborative processes between stakeholders and communities to identify the needs and pursue corrective strategies. They facilitate equal participation where everyone shares information, perspectives, clarification of viewpoints and developing solutions. Communities are empowered to develop local solutions to achieve common goals and to overcome barriers.

Researchers at Makerere University Centre for Health and Population research (MUCHAP) conducted such engagements in Eastern Uganda to discuss issues around immunization programs, vaccine safety and introduction of new vaccines for pregnant women. Emphasis was on joint problem identification and analysis to craft a preferred state. Sessions were participatory and empowering for members, deepened understanding through listening, and common goals and action points were developed. Participants understood vaccine preventable illnesses as both infectious and non-communicable diseases with some not having any known vaccine.

Some of their sentiments on maternal and neonatal immunization, and introduction of new vaccines were legitimate while others were inaccurate: ‘new vaccines should be brought to market when it has no side effects’;‘it is important to save lives of pregnant women if the older vaccines have weakened, new vaccines are good for pregnant women because many get affected with several medical problems, new vaccines will fight against the increasing diseases which are harmful to the health of pregnant women like candida’; ‘it may reduce the number of pregnant women who undergo caesarean section during times of delivery’. Such views point to vaccine acceptability.

Negative opinions related to immunization of pregnant women included: ‘during the introduction of Hepatitis B vaccine, some people were told that the vaccine may prevent them from giving birth’;‘new vaccines may lead to delivery of deformed babies’, and ‘they want to deter young potential mothers from producing children to control population size and their children will not be pregnant in future through the introduction of new vaccines’.

The two major causes of infant deaths that disproportionately impact those living in LMICs are Group B streptococcus (GBS) and respiratory syncytial disease (RSV). No licensed vaccines currently exist against GBS, but work is underway to develop a vaccine that can begiven to pregnant women so that newborns are protected even before birth. On the other hand, the treatments available for RSV are limited but several vaccines are in development.

As we wait for the vaccines in pipeline, it is important to listen to communities through engagements. This will (a) correct the misinformation and negative narratives, (b) mitigate the spread of negative stories by some groups out of ignorance (c) improve health literacy, and (e) access organic information from those impacted by such interventions. If the negative narratives are not explained to clear false impressions, we risk avoidable vaccine preventable morbidities and mortalities now and in future.

By Dan Kajungu Msc. PhD
Lead Research Scientist and Director, MUCHAP
Vaccines and Medicines safety Researcher

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Boy Children Report More Physical & Emotional Abuse

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Men in the intervention group during the Parenting for Responsibility (PfR) project training session.

By George Kisetedde

On 3rd August, 2022, the CHDC (Child Health and Development Centre) disseminated study findings from one of the research studies carried out at the centre. These findings were presented under the title,“The Prevention of Violence against Children and Women: Baseline and Implementation Science Results from Parenting Cluster Randomised Trial.” Moderated by Dr. Anthony Batte, a lecturer at CHDC. Study findings were presented by Joseph Kahwa, the trial manager of the Parenting for Responsibility (PfR) project, under which this study falls.

Kahwa described PfR as a community based parenting programme delivered to both male and female parents. This programme aims to improve parenting skills, prevent violence against children, and to improve spousal relationships.

Findings from the study

Findings from this study showed that parents maltreat boy children more than girl children. The boys reported more emotional and physical violence than girls. Furthermore, the boy children reported that male caregivers specifically, maltreat them more. On the other hand, the girl children reported more sexual violence from caregivers than boys. On the whole, the children reported that female caregivers emotionally and physically abused them more compared to male caregivers.

More findings, according to Kahwa, showed that 46.5% of parents in Amuru can provide their children with soap to wash, 44.5% can provide school fees, 44.4% can provide school materials, 44.2% can provide new clothes, 43.3% can buy school uniform, and 35.9% can provide a pair of shoes.

How the research is conducted

The study is divided into 16 group sessions. The first 9 sessions are single sex, that is, male caregivers and female caregivers train separately. The next 7 sessions are mixed with male and female participants combined during training.

A mixed group parenting session for both men and women.
A mixed group parenting session for both men and women.

Kahwa explained that this programme was initiated to deal with VAC (violence against children) and IPV (intimate partner violence). These two vices are closely linked and have a significant impact on how children turn out.

Kahwa added that the PfR research programme aims at addressing the four major factors that may lead to VAC/IPV. These include; poor parental bonding, harsh parenting, unequal gender socialisation and spousal relationships.Poor parental bonding refers to the absence of a healthy close connection between a parent and their child. When a parent and child are not close, the parent may lack empathy for the child and the ability to perceive and respond to their child’s needs. When this bond is weak, a parent is unable to appreciate a child’s needs and can end up being unrealistically tough, which results in harsh parenting. Unequal gender socialisation generally refers to the different expectations that parents have of their children depending on their gender-male or female. The quality of the spousal relationship between parents also affects a child’s life. These four areas are what the parenting sessions concentrate on during the training.

The PfR study employed a cluster randomised controlled trial (RCT) design. Male and female caregivers were recruited from cluster villages in the Wakiso and Amuru districts in Uganda. One child aged 10 to 14 per household was randomly selected and assessed.

The caregivers were divided into two groups; the intervention group and the control group. The intervention group underwent all the 16 sessions of the training while the control group underwent a 2 session lecture on parenting. The impact of the PfR intervention was then ascertained by comparing baseline and endline results (or the before-and-after experiences of parents). The study participants were from 54 Villages selected in both Amuru and Wakiso districts. 108 caregiver groups (54 groups per intervention)were selected. This resulted in 2328 parents recruited and 886 children.

In conclusion, Mr. Kahwa said that maltreatment is still prevalent in the population. Generally, the PfR programme was well-received by parents and it had ad good attendance from parents. The programme also registered good male engagement. The peer facilitators who were recruited also had great potential in expanding the PfR programme at community level.

This study was conducted by Dr Siu Godfrey as the Principal Investigator. Other members of the team included Carolyn Namutebi, Richard Sekiwunga, Joseph Kahwa, Dr Betty Okot, and Martha Atuhaire. They were supported by the Director from CHDC, Dr. Herbert Muyinda and the CHDC Finance & Administration team. The team from Glasgow & Oxford Universities in the UK included, Prof Daniel Wight, Dr Jamie Lachman , Francisco Calderon and Dr Qing Han. On the other side, the team from the SOS Children’s Village from Gulu and Wakiso included, Rachel Kayaga, Sindy Auma Florence and Godfrey Otto.

Contact: George Kisetedde – kisetedde@gmail.com | Edited by Agnes Namaganda – agnesvioletnamaganda@gmail.com

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Makerere Medical Journal: Golden Jubilee Edition 2022

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Cover Page of the Makerere Medical Journal Golden Jubilee Edition 2022.

It’s with great pleasure that I welcome you to the Golden Jubilee edition of this phenomenal journal. Yes, The Makerere Medical Journal marks 50 years of publication with this year’s edition and all this has been made possible by the endless efforts and contributions of the Makerere University College of Health Sciences Staff and students because without your research submissions and financial support, the journal wouldn’t have made it this far. To you reading this, thank you for contributing to the sustainability of this great project, year in year out.

Here’s a quote to ponder on as you delve into this year’s well-crafted articles and it’s by Zora Hurston (1891-1960), “Research is formalized curiosity. It is poking and prying with a purpose.” And doesn’t that just define our purpose as researchers?!

This edition’s articles cover pertinent topics ranging from Antimicrobial Stewardship, COVID-19 interventions, Oral Health amongst others. It also features student projects, write-ups on student-led organizations and societies that are making a difference in the life of a health sciences’ student and many more interesting writings. Featured in this issue are international manuscripts from countries like Nigeria and we were also honored to work with other universities within the country and feature some of their students’ articles.

I would like to extend my most sincere gratitude to my team of editors that engaged in a rigorous peer review process to ensure that the articles published are up to standard. As the editorial team, we are quite pleased to see the number of undergraduates involved in research steadily increasing and all the efforts that have been put in by the different stakeholders to see this happen are commendable.

With that said, I hope you enjoy every second of your read!!!

LINDA ATULINDA,
MBChB IV

EDITOR-IN-CHIEF,
Research and Writers’ Club 2021-2022

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Call for Applications: HEPI Masters Support Fellowship

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Panelists L-R: Professor Elsie Kiguli-Malwadde, Professor Francis Omaswa, Professor Jehu Iputo and Professor Joel Okullo at the HEPI-ACHEST Health Professions Education Symposium, 17th June 2022, Makerere University.

Applications are invited for the Health Professional Education Partnership Initiative (HEPI-SHSSU) Masters fellowship programme support from postgraduate students of:

  • Makerere University College of Health Sciences (MakCHS)
  • Kabale University School of Medicine
  • Clarke International University
  • Faculty of Health Sciences, Busitema University

The programme will support graduates in their final year of training leading to the award of a Masters degree on any of the Master’s graduate training programs at the stated University for a maximum of 19 successful candidates.

The closing date for the receipt of applications is 30th September 2022.

Inquiries and Applications must be submitted to hepishssu@gmail.com

See attachment for more details 

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