Health
Address Drivers of Non-compliance to COVID-19 Guidelines, Researchers Urge Government
By Joseph Odoi
Makerere University researchers and local leaders have asked government and other key stakeholders in refugee management to address community drivers of non-compliance to COVID-19 guidelines as increased cases continue to be registered across the country.
This call was made at the dissemination event of a study conducted by Makerere University titled Refugee Lived Experiences, Compliance and Thinking (REFLECT) in COVID-19. The REFLECT dissemination was undertaken at multiple sites in Kisenyi (Kampala), Kyaka II Refugee Settlement (Kyegegwa) and Adjumani (West Nile) on 14th December 2020.
The REFLECT study observed that compliance levels around COVID-19 guidelines drastically declined between May-August 2020 and continue going down despite increased infections from community transmission. The stakeholders at this event cautioned that addressing the drivers of non-compliance was necessary in light of the overwhelmed health system, currently ongoing political campaigns and massive social gatherings in the Christmas season and beyond.
Since March 2020 the Uganda government and its partners have conducted a fairly successful awareness campaign on the prevention of COVID-19. However, this knowledge has not translated into sustainable behavioural change and while there was strict observance of COVID-19 at the start of the pandemic, compliance has drastically dropped due to a number of reasons. This is why all prevention efforts should now focus on addressing the barriers to non-compliance as the country enters into the second wave and peak period of COVID-19 transmissions.
A study conducted from among 2,092 people in refugee settlements in Uganda has found a serious disconnect between the high knowledge levels and levels of compliance with the recommended COVID-19 preventive measures. A total of 13 settlements were considered for this study including Kisenyi in Kampala, Kyaka II in Kyegegwa district and 11 settlements in Adjumani district, West Nile.
Presenting findings of the study at Kyaka II Refugee Settlement in Kyegegwa, South-Western Uganda, the research team led by Dr Gloria Seruwagi observed that compliance levels had declined over time (between March/April and July/August); unfortunately coinciding with increasing number of COVID-19 cases and deaths.
Inappropriate use of masks was found prevalent in some of the study sites – including sharing of masks, and only wearing them when the refugees meet the Police. Researchers say these practices constitute a source of risk for infection, rather than being protective.
Scarcity of Facemasks
Sifa Mubalama, a Woman Councillor in Kyaka II while speaking to study investigators at Kyaka II Refugee Settlement in Kyegegwa, South-Western Uganda late last year, revealed that there is non-compliance to COVID-19 guidelines due to inadequate masks and materials at the settlement.
“We were all given one mask each in Kyaka II settlement which you have to wash often and use again, hence becoming too old getting torn after some time. There is also inconsistent supply of soap and water. Because of this, some of the community members have not been washing their hands consistently’’ Mubalama revealed.
According to Mubalama, each family gets Shs. 22,000 every month, which is she says is not adequate to sustain the families. As a result, majority refugees go out in the communities to do manual work, to supplement on the income citing that this puts their lives at risk of COVID-19 infection.
Mubalama further contends that children in the settlements were not adhering to the Standard Operating Procedures (SOPs) because their parents were not.
“It would be easier to implement these guidelines if the parents were adhering to them. Because the parents are not adhering to the guidelines, most children are also not. It’s really important that if we are to implement the SOPs, it should start from the parent,” she said.
According to Happy Peter Christopher, the Kyegegwa Sub County Speaker, ever since the lockdown restrictions were eased, the refugees abandoned following the COVID-19 guidelines like social distancing, wearing masks, sanitizing or frequent washing of hands with soap.
“People are not putting on masks and are careless. Refugees also buy food from the nationals and there are intermarriages. So, the spread of COVID-19 is very possible. For us we would like, if possible, to ask government to bring back the total lockdown so that we are protected”.
He also reported that, up to now, some areas in Kyegegwa had still not received the government distributed masks and called upon government to deliver masks to all refugees and also add more efforts in enforcing SOPs.
It is against this background that researchers at Makerere University and local leaders have appealed to government and other stakeholders in the refugee management to address the community drivers of non-compliance to COVID-19 guidelines as cases continue to surge in Kyaka II refugee settlement in the South Western district of Kyegegwa.
Government has been asked to address the drivers of non-compliance, as a necessity in light of the overwhelmed health system, by the currently ongoing political campaigns and the massive social gatherings during the festivities.
Dr. Misaki Wayengera the Chairperson of the Scientific Advisory Committee on the COVID-19 Taskforce in the Ministry of Health explained why some districts did not get enough masks, saying there was an urgency to distribute to candidates returning to school.
“We intended to distribute masks to the entire 139 districts of Uganda. However, this was not possible because we opened up schools. As the Ministry [of Health], we had to negotiate with the Ministry of Education to prioritise the candidate students who were going to school; every student receiving 2 masks. As a result, we have not been able to distribute masks across the entire country,” he explained.
According to Dr. Wayengera, there is a need for all stakeholders dealing with refugees to appreciate that they are equally susceptible to COVID-19 like any other person.
“In terms of providing support, we must ensure that we provide things like masks, soap, sanitizers and also educational materials around the SOPs,” he said.
Adding that; “there are targeted efforts to make sure that we roll out Rapid Diagnostic Tests to make sure that we can screen the populations especially as children go back to school, we screen them but most importantly know who is infected and pull them out from the community”.
Discussion of Study Results
Dr. Gloria Seruwagi, also the Principal Investigator notes that whereas more than half (about 60 percent) of the members of the refugee community are well informed about COVID-19; up to 40% were found to have knowledge gaps on the nature, transmission, symptoms and dangers of COVID-19.
The study results also showed that between 1-40% of the refugee population across the different study sites adopt at least one risk behaviour likely to lead to transmission of COVID-19 including behaviours related to hygiene and social interactions including related to hygiene, congestion, and physical activity.
While men appeared more knowledgeable about the virus compared to women and children, women were found to be more compliant than men. Also, refugees who were Muslims were more compliant to COVID-19 guidelines compared to their Christian counterparts while younger refugees appeared more knowledgeable about COVID-19 than the elderly.
A wide knowledge gap was found among the children and adolescents, with up to 75% not fully knowledgeable on causes, transmission, risk/protective factors and management of Covid-19.
The Myths
Study results show that refugee communities had a belief that Africans have immunity against COVID-19; and that COVID-19 is not real but is instead a fabrication of scientists and politicians; and that their religious faith would protect them.
On threats and opportunities towards compliance, social media and the diaspora were reported as the key knowledge agents among refugee communities whose effect is divisive by simultaneously encouraging both compliance and non-compliance.
While a lot of information about COVID-19 has been provided by government and other stakeholders including implementing partners from civil society, UN bodies and local leadership, researchers revealed that children, youths and s the elderly and people with disabilities were not particularly targeted with appropriate information; and had largely not been reached.
Children and COVID-19
During the investigations, researchers found that despite government and other key and agencies churning out COVID-19 related information, it largely focused on adults and missed out children and adolescents.
“The fact that they (children and adolescents) have not been targeted means that no one has even given them masks. The masks which are on the market are all big and if a child wears it, it is going to fall down. We decided to channel some of the study resources into making customised and re-usable masks for some of the older children,” explains Dr. Gloria Seruwagi.
Behavioural change messages needed
The REFLECT study team observed during the study that there was a great and urgent need for engaging leadership at all levels as well as developing Behavioral change messages to positively influence behavior.
During the dissemination exercise, the REFLECT Study Team donated masks to support the refugees “walk the compliance talk” in the fight against COVID-19.
The study team physically sensitised and demonstrated to the refugees on proper wearing of masks. They strongly discouraged the improper use of masks including “chin” masking, partial masking, inconsistent masking, sharing of masks as well as wearing ill-fitting masks.
On the whole, researchers applauded government and development partners’ efforts on undertaking a largely successful awareness campaign around COVID-19.
They note however that this awareness has not translated into positive change, emphasising the need for more effort towards behavioural change, building on from the COVID awareness campaign.
The research team recommends thus;
- Government and all stakeholders should focus on addressing the drivers of non-compliance and enforcement fatigue. These drivers include:
- Reviewing the feasibility of interventions: Guidelines like physical distancing are not feasible in crowded refugee settings and need to be revisited. For crowded settings emphasis needs to be put on some guidelines and not others, for example handwashing and consistently wearing fitting face masks instead of physical distancing or sanitizing.
- Debunk myths and negative perceptions: Majority of the community has not fully bought into the seriousness of COVID-19 and think it is not only a joke but is also a political and monetary ploy advanced by politicians, some scientists, supremacists or population control enthusiasts. These myths need to be debunked and instead replaced with factual information about COVID-19.
- More profiling of COVID-19 trends and cases should be undertaken for behavioural change impact. This is because more than 90% of study participants had not seen a single COVID case. However, stigma and other potentially related dilemmas should be carefully managed.
- Leaders, implementers and enforcers of COVID-19 guidelines should be consistent and “walk the talk”. This is especially needed now with the political campaign season where masses are gathering and politicians are not leading by example.
- The issue of livelihoods and food security must be resolved as a key bottleneck to compliance.
- Culture: Local leaders, cultural leaders and grassroots organisations should be recognised and engaged more in behavioural change campaigns – for instance to engage their communities identify alternative social norms for greetings, for showing love and kindness etc., without put their lives at risk.
- The timeliness and critical role of the recently launched 2020 Community Health Engagement Strategy (CES) should be leveraged whereby:
- Local health system capacity is strengthened to effectively take up the implementation and enforcement of SOPs for COVID-19 prevention.
- Community health systems and other enforcement structures are equipped with knowledge, skills, supplies and adequate infrastructure.
- Key sociodemographic factors and COVID-19 risk should guide tailored impact messaging and other interventions.
- Children, adolescents and youth should be effectively targeted in COVID-19 interventions. They need awareness, products (e.g. fitting face masks), visibility, voice and protection from the effects of COVID-19 including being witnesses and victims of different forms of violence.
- The awareness message found high among adults should be reinforced and consolidated – equitably this time.
“We believe that these are low-cost interventions but which will bring about high impact in a very short time and reverse not only the trend of COVID-19 transmission but also its negative effects across the health socioeconomic spectrum” Dr Seruwagi said.
Kyegegwa Authorities Speak Out
Jethro Aldrine, the Kyegegwa District Assistant Resident District Commissioner said government was committed to inclusive dissemination of information on MOH SOPs in order to mitigate the spread of the pandemic.
“As the COVID-19 district task force, we move from door to door to sensitize people on COVID-19 including children,” he disclosed.
He also noted that government was also sensitising the masses through radio stations to create awareness that COVID-19 is real and needs to be prevented. He thanked the REFLECT Project for carrying out the study that will help the district fight the current pandemic.
At a radio talk show conducted jointly with the study team, district officials and refugee community leaders, Mr Thomas Mugweri the Surveillance Officer in the District Health Office of Kyegegwa District Local Government also thanked the REFLECT Study Team for giving it new direction.
“While we as a district have been massively sensitizing on awareness, now we know that people are not using the message they know about COVID. We are now going to start using all our behavioural change techniques to make sure that we bring out the desired behavioural change,” observed Mugweri
He urged the politicians to stop recklessly endangering the masses by calling them to campaign rallies and instead called upon them to donate masks and lead by example through observing COVID SOPs during their campaigns.
Youth Voices on COVID-19 in Refugee Settings
As part of increasing the visibility and voice of young people in COVID-19, the REFLECT Study organised an engagement session with children, adolescents and youth during the dissemination. The engagement sessions were led by Francis Kinuthia Kariuki and Grace Ssekasala of Centre for Health and Social Economic Improvement (CHASE-i) who were supported by Catherine Nakidde Lubowa and Dr Gloria Seruwagi the study PI.
During this exercise, the REFLECT Team discussed Coronavirus and it emerged that a number of issues are affecting the children and youth which needed to be addressed alongside COVID-19 prevention. Most critical, children and adolescents reported defilement, rape – leading to teenage pregnancies and a lot of other SRH challenges that affected their sexual health.
Many confessed they lacked information on menstruation hygiene products which citing that some of their families could not afford. Others decried inaccessibility of contraception despite being sexually active and access to youth-friendly counselling on SRH matters affecting them.
Both male and female youths agreed that the high level of teenage pregnancies has been attributed to high poverty levels and being out of school. ‘’Sex is being used as a tool for economic gain and survival. This is not limited to the girl child only – two cases were reported where boys are being married by older women who lure them with money and soft life’’ explained Mr. Francis Kinuthia from his engagement with adolescent boys and youth.
Mental health issues were reported to be affecting adolescents largely boys who expressed worry about their future especially, now, that schools had been closed, and they are in a foreign country.
Increasing crime rates were also reported and, following unemployment plus school closure, majority youths especially males have now resorted to drugs and substance abuse.
In regard to COVID-19 the adolescents in general reported that they had experienced the negative effect of the pandemic in their lives such as reduction on monthly hand-outs, harassment by police and enforcers of COVID -19 guidelines, increased domestic violence, SGBV, teenage pregnancy, increased levels of drug and substance abuse, poor mental health and high cost of living among others.
Asked what could be done to solve some the challenges they were facing; youth recommended the following;
- Establishment of skill development centres to empower them and make them less dependent on hand-outs
- Creation of employment opportunities by authorities
- Identification, support and nurturing talent among them refugees and youths
- Constant supply of sanitary towels/pads and other SRH products including contraception
- Health education on contraception methods and having in place youth-friendly services at health facilities
- Continuous awareness campaign on COVID-19 which involve youth and punitive policies or by-laws to severely punish the perpetrators of teenage pregnancies, rape and child marriages.
The dissemination attracted members of the academia from Makerere, Gulu and other universities, central and district Government representatives, Refugee Representatives including their leadership from OPM, Refugee Welfare Committees (RWC), Village Health Teams (VHT), Youth, Women and Sub-County representatives, local politicians, Development and Implementing Partners like Save the Children, Red Cross Society, UNHCR, Nsamizi Institute for Social Development and the Private Sector.
Research Team
The REFLECT Study is funded by Elrha/R2HC (Research for Health in Humanitarian Crises) supported by UKAID, Wellcome and National Institute for Health Research (NIHR). The Study Team is led by Dr. Gloria Seruwagi.
The full team has Prof. Stephen Lawoko of Gulu University, Dr. Denis Muhangi, Dr. Eric Awich Ochen, Dr. Betty Okot all from Makerere University, Andrew Masaba of Lutheran World Federation (LWF), Dunstan Ddamulira from Agency for Cooperation and Research in Development (ACORD and John Mary Ssekate from the National Association of Social Workers of Uganda (NASWU) Others are Brian Luswata and Joshua Kayiwa all from the Ministry of Health and Catherine Nakidde Lubowa, the Project Coordinator.
Article originally posted on MakSPH
As the funding to the higher education sector keeps on reducing due to competing priorities, universities are implored to come up with structures and strategies to attract and win research grants.
Key findings indicate that universities with institutionalized grant management offices, strong and coordinated research teams are better positioned to effectively compete for grants.
Makerere University, in partnership with Northwestern University, is spearheading the E-SMAC G11 Grants Administration and Management workshop from 14th to 17th July 2025, aimed at strengthening grant management offices and systems among the participating universities and entities.
It is envisioned that through this capacity building approach, the workshop which brings onboard over 130 participants from different universities and entities, will address the knowledge and skills gaps among faculty, grant managers, administrators and support staff.
The participating universities and entities include: Makerere University, Uganda Christian University-Mukono, Soroti University, Gulu University, Clarke International University, King Ceasor University, Kyambogo University, Muni University, Mother Kevin University, Uganda Martyrs’ University-Nkozi, Ernest Cook University, Mbarara University of Science and Technology, University of Kisubi, Kabale University, Busitema University, BRAC University, Infectious Diseases Institute, Ministry of Health, and among others.
Makerere University and Northwestern University have built a strong partnership over the past decade through academic exchange, collaborative research, and capacity building initiatives. “Since 2020, the institutions have deepened their collaboration in research administration through the UASP fellowship, sharing best practices and co-developing of sustainable systems to strengthen research management,” said Prof. Sylvia Antonia Nakimera Nannyonga-Tamusuza, Head of Grants Administration and Management Support Unit (GAMSU) at Makerere University.
She informed the participants that Northwestern University has been instrumental in building the capacity of staff at Makerere University in grants writing, management and administration.
Prof. Nannyonga-Tamusuza testified that when she was appointed to head GAMSU, she received comprehensive training from Northwestern University, which enhanced her competences and expertise in the field. She acknowledged Kate Klein from Northwestern University for the mentorship that empowered her with valuable knowledge and skills. She reported that five (5) members of staff from Makerere University had been trained by Northwestern University in grants and research management.
Filled with joy, she introduced the team of experts from Northwestern University namely Kate Klein, Bethany Ekesa and Elizabeth Christian to Makerere University, and applauded them for accepting to be facilitators. Prof. Nannyonga-Tamusuza assured the workshop participants that the team from Northwestern University would not only train them, but would share best practices in grants management and administration as well as networking opportunities.
The training workshop is part of the Expanded Strengthening of Makerere University’s Research Administration Capacity (E-SMAC) program, which focuses on enhancing research administrative systems and staff capacity at Makerere University and its partner institutions. Mordecai Tayebwa is the Program Director and Principal Investigator of the E-SMAC program being implemented from July 2024 to December 2025. The program is funded by the National Institute of Allergy and Infectious Diseases (NIAID).
The workshop provides a platform to build faculty, grant managers and administrators capacity in grant writing and management, foster cross-functional collaboration across departments, strengthen understanding of budget creation, biosketch and funder systems, encourage mentorship and peer to peer learning, and lay a foundation for regular support.
The training tackles four broader themes namely Grants Introduction and Systems, Proposal Development, Capacity Building, and Outcomes and Forward Planning. It covers vital areas such as grant writing, budgeting, funder systems, compliance, and overall grant administration. It features practical sessions, mentorship opportunities, and collaborative learning, with the goal of strengthening pre-award and post-award grant management and improving research productivity and compliance.
Opening the workshop, the Acting Deputy Vice Chancellor (Finance and Administration) at Makerere University, Prof. Winston Tumps Ireeta urged universities to institutionalize grant management offices and policies as well as strengthening research systems through collaborations.
Sharing his experience, Prof. Ireeta informed the participants that he was involved in the strategic discussion that led to the establishment of GAMSU at Makerere University. “We observed that Makerere University School of Public Health had established a grants office, which was instrumental in attracting and winning funds for research. We were inspired by this best practice. Thus, a comprehensive policy was developed to streamline and strengthen grants management across all colleges at the University,” he said.
Prof. Ireeta noted that Makerere University commits to being a research-driven institution, a strategic direction, that needs a strong funding base. ‘Research grants are therefore a key resource,” he said.
Stressing the importance of adhering to the technical details in the grants management processes, Prof. Ireeta appealed to the participants to be active listeners and maximally utilize the moment to learn from the experienced facilitators.
In the same vein, Prof. Nannyonga-Tamusuza, applauded the University Council and Management for the strategic direction undertaken to elevate GAMSU from a Unit to a Directorate. This points to the central role of the grants office in the life cycle of Makerere University. She pointed out that GAMSU reports to the Vice Chancellor through the Deputy Vice Chancellor (Finance and Administration).
Established by the University Council in 2020, GAMSU is a central office at Makerere University. It provides professional and coordinated services across the entire grant life-cycle-from identifying funding and developing proposals to ensuring compliance, project execution, financial oversight, and institutional capacity building. GAMSU works closely with academic and administrative staff to support competitive, well-managed and accountable research.
Focusing on the training workshop, Prof. Nannyonga-Tamusuza called upon the participants to utilize the golden opportunity to deepen their understanding of grants management in advancing research. She acknowledged the role of this collaboration in fostering mutual learning and the sharing of best practices, noting that such initiatives were key in ensuring that research conducted by universities aligns with global standards. She encouraged participants to engage fully in the workshop, collaborate with their peers, and build lasting connections to foster continuous learning.
The Administrative Director of the Havey Institute for Global Health at Northwestern University, Kate Klein, noted that grants administration goes beyond securing funding. She explained that grant administration is about building strong, sustainable systems that support researchers, facilitate collaboration, and ultimately contribute to solving global challenges.
Klein stated that grants administration and management require continuous learning, adaptability, and a strong foundation in regulatory and financial oversight.
“Collaborating and learning from one another is essential,” Klein stated. “When grants administration is effectively managed, it becomes a powerful catalyst for driving impactful change in research, ultimately advancing global initiatives that address the world’s most pressing challenges.”
She urged participants to critically analyze their current systems and identify areas where improvements could be made. By doing so, they would be better positioned to manage grants effectively and maximize their impact. She guided that a research grants administrator should be able to design monitoring frameworks, liaising with funders to address grant-specific issues, coordinating compliance, budgeting and reporting to ensure timely and effective implementation.
Presenting the Existing Support Systems and Principal Investigator (PI) agreements, Prof. Nannyonga-Tamusuza pointed out the critical role of GAMSU in maximizing Makerere University’s access to grants. This is particularly important in the context of limited financial resources, where GAMSU ensures that the university effectively leverages available funding opportunities.
Prof. Nannyonga-Tamusuza explained that GAMSU ensures research projects align with the priorities of funders and comply with both institutional and external regulations. She emphasized that this alignment is essential for securing and managing grants successfully. She stated that oversight offered by GAMSU, helps streamline the process for researchers. She pointed out that grant management is a collaborative process, involving multiple stakeholders across the university, which ensures that the necessary expertise and support are in place to manage grants effectively.
Underscoring the importance of grant negotiations, particularly with sub-award grants, Prof. Nannyonga-Tamusuza clarified that such negotiations are most successful when managed at the institutional level, where GAMSU oversees the entire lifecycle of a grant-from identifying funding opportunities to post-award activities.
Harriet Nambooze, the Project Coordinator at Makerere University School of Health Sciences, provided participants with a detailed guide on navigating the National Institutes of Health (NIH) grant application process. She introduced essential tools such as Grants.gov, eRA Commons, SAM.gov and the NATO Commercial and Government Entity (NCAGE), which are critical for applying and receiving an NIH award.
Nambooze stressed the importance of accurately setting up roles in the eRA Commons system, including Signing Official (SO), Principal Investigator (PI), Account Administrator (AA), and Administrative Official (AO), as well as ensuring that profiles are up-to-date across various systems.
She highlighted the necessity of adhering to NIH’s strict submission deadlines and maintaining active individual and institutional profiles to facilitate timely applications. She recommended that institutions should appoint multiple Signing Officials (SOs), to avoid any delays with the required submissions.
Presenting to the participants, Mordecai Tayebwa shared a detailed, step-by-step guide to starting a new grant application. He explained the key elements of the grant process, including the necessity of including a budget, adhering to specific formatting guidelines, and uploading required documents, such as the foreign justification for international projects.
He pointed out the need of thoroughly verifying the application before submission to ascertain that all required documents are included. “This step is crucial to avoid errors that could delay or jeopardize the submission,” he said.
The first day of the workshop set a strong foundation for enhancing grant administration capacity among the participating universities. Participants were equipped with knowledge and skills in grant systems at the national and global levels.
Day two, will focus on topics such as reading funding opportunity announcements, tailoring writing, budget development and justification, sub-contract management, sub-recipient monitoring, and Memoranda of Understanding (MoUs).
On Day three, the participants will gain a deeper understanding of the Grants Office, financial management, internal controls and reporting, peer review process overview and project closeout.
On Day four, the participants will witness the launch of the MakGAP (Makerere University Grants Professional Initiative), listen to a keynote speech on grants management from the Vice Chancellor of Makerere University, Prof. Barnabas Nawangwe, as well as presentations on professional growth through MakGAP, CRA Exam, and Global Research Administration Networks, and professional recognition of research managers and administrators in Africa and post evaluation.
The first day of the workshop set a strong foundation for enhancing grant administration capacity among the participating universities. Participants were equipped with knowledge and skills in grant systems at the national and global levels.
Day two, will focus on topics such as reading funding opportunity announcements, tailoring writing, budget development and justification, sub-contract management, sub-recipient monitoring, and Memoranda of Understanding (MoUs).
On Day three, the participants will gain a deeper understanding of the Grants Office, financial management, internal controls and reporting, peer review process overview and project closeout.
On Day four, the participants will witness the launch of the MakGAP (Makerere University Grants Professional Initiative), listen to a keynote speech on grants management from the Vice Chancellor of Makerere University, Prof. Barnabas Nawangwe, as well as presentations on professional growth through MakGAP, CRA Exam, and Global Research Administration Networks, and professional recognition of research managers and administrators in Africa and post evaluation.
Based on research led by Max Bobholz and colleagues from Makerere University in Uganda, Essentia Institute of Rural Health, and the Medical College of Wisconsin in the United States.
Adolescence is meant to be a time of holistic growth and self-discovery, but for many Ugandan teenagers, this period is becoming a season of silent mental health struggles. A new study published in PLOS Global Public Health has uncovered a silent but growing crisis: nearly one in five Ugandan secondary school students in the study areas have signs of an emotional disorder. These conditions included anxiety, depression, post-traumatic stress disorder (PTSD), and adjustment disorders often involving excessive worry, sadness, fear, or mood instability. Also, one in 20 adolescents exhibited behavioral issues ranging from attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder to substance use and other risky behaviors like alcohol use.
The study, led by Max Bobholz, a PhD candidate in Public and Community Health at the Medical College of Wisconsin, surveyed a sample of 1,953 students aged 10 to 18 years enrolled in eight secondary schools in Iganga district in Eastern Uganda and Mukono district in Central Uganda. This was one of the most comprehensive efforts yet to understand the prevalence and drivers of mental health challenges among school-going Ugandan adolescents.
“We are looking at a generation facing a complex blend of stressors, namely, academic, social, and emotional,” says Bobholz. “Our findings show that certain groups are especially vulnerable, and schools need to be equipped to respond.”
This study results, published on June 12, 2025 was funded by the Swedish International Development Cooperation Agency (SIDA), a government agency of the Swedish Ministry for Foreign Affairs, through the Makerere University Postdoctoral Fellowship to one of the investigators, Dr. Catherine Abbo. Other researchers included Julia Dickson-Gomez, Arthur Kiconco, Abdul R. Shour, Simon Kasasa, Laura D. Cassidy, and Ronald Anguzu.
According to the study, girls bear a higher emotional burden. Researchers found that female students had nearly two times higher odds of suffering from emotional disorders such as anxiety or depression than their male peers.
Dr. Catherine Abbo, an Adolescent Psychiatrist and Associate Professor at Makerere University, attributes this to both biological and socio-cultural factors. “Puberty brings hormonal shifts that can heighten emotional sensitivity,” she explains. “But just as importantly, Ugandan girls often face intense pressure to conform to gender roles while also navigating issues like body image, harassment, and future uncertainty.” The researchers are calling for gender-sensitive mental health interventions, particularly in schools, where early support could help mitigate long-term mental health issues.
Higher associations in older teens?
Age also emerged as a key associated factor, with each additional year increasing the odds of behavioral disorders by 20%. “As adolescents grow older, they are more prone to risk-taking, impulsivity, and resistance to authority,” explains Dr. Simon Kasasa, a senior lecturer and biostatistician at Makerere University School of Public Health.
“Combine that with academic pressure and identity-related stress, and it’s no surprise we’re seeing more conduct issues in late adolescence,” Dr. Ronald Anguzu, an Assistant Professor in the Institute for Health and Humanity at the Medical College of Wisconsin, added. This study raises critical questions about whether and how Ugandan secondary schools support older students as they transition toward adulthood.
The unseen influence of family mental health
The study also found that adolescents with a family history of mental illness had twice the odds of exhibiting behavioral problems compared to those without such a history.
“This speaks to the intersection of genetics and environment,” says Bobholz. “Living in a household with people affected by mental illness can mean instability, stigma, and lack of emotional support, all of which weigh heavily on a developing mind.”
The authors recommend that school mental health screening include family mental health history and advocate for greater collaboration between education and health sectors to support at-risk households.
Private schools: High marks, higher stress?
Interestingly, students in private schools had 1.4 times the odds of experiencing emotional disorders compared to those in public schools. Private schools, often seen as academic havens, may inadvertently be cultivating high-pressure environments. “There’s an assumption that better facilities mean better well-being,” says Dr. Abbo. “But intense academic competition, social isolation, and a lack of trained counselors can create emotional pressure cookers.”
Previous research in 47 secondary schools across five districts (Rakai, Kyotera, Masaka, Lwengo, and Kalungu) in southwestern Uganda found that economic and family support helped reduce absenteeism among adolescent girls in secondary schools. However, this support did not significantly improve behavior or reduce grade repetition. The region, which includes districts like Rakai and Masaka, also faces a higher burden of HIV, adding to the challenges young people experience.
Meanwhile, a review of data from 42 primary schools in Luwero District identified school-based mental health interventions such as cognitive behavioral therapy and mindset-building approaches as being particularly effective. Researchers now suggest that integrating these strategies, along with efforts to reduce school violence, could go a long way in improving the mental health of Ugandan adolescents.
A-Level pressure: Academic ambition meets mental health strain
The study also found a correlation between advanced (A’level) education and increased risk of emotional disorders. “We selected one school district from each region based on population and past academic performance. As these students prepare for university or the job market, the pressure to succeed becomes enormous,” says Kasasa. “They’re facing a future full of uncertainty, with very little structured mental health support to help them cope.”
A wake-up call for Uganda’s education and health systems
The authors of this study assert the urgent need for school-based mental health programs, especially in private and A-level institutions. These programs should offer routine screening, emotional support, and training for teachers to recognize warning signs of mental health disorders.
Importantly, this study adds weight to calls for a national adolescent mental health policy, tailored to Uganda’s context, with interventions that bridge health, education, and social services.
“Our data shows that mental health challenges are not a fringe issue,” says Bobholz. “They are widespread, significant, and deeply tied to school, home, and society.”
The COVID-19 school closures between 2020 and 2022 deepened feelings of isolation and financial strain, with out-of-school adolescents reporting depression rates as high as 21.5% to 50% higher than their peers who remained in class, according to research published in February 2025. Yet Uganda invests less than 1% of its health budget in mental health, with just one psychiatrist per million people, leaving many teens to cope through cheap alcohol used by 28% of urban youth or untrained healers, as reported by the government paper The New Vision in April 2025. With only 26% of students completing lower secondary school and 35% of the population under age 24, these mental health challenges now pose a serious threat to the country’s future.
Mercy Akankunda of Proven Foundation, a Ugandan NGO supporting vulnerable groups, warns that mental health struggles are quietly eroding the well-being of the country’s youth, over 12 million strong and making up 35% of the population. “These teens are not just statistics. They are the future of Uganda, she asserts. If Uganda hopes to reap the dividends of its young population, addressing adolescent mental health must become and remain a national priority, not just for treatment, but for prevention, resilience, and hope.
Reference:
Bobholz, M., Dickson-Gomez, J., Abbo, C., Kiconco, A., Shour, A.R., Kasasa, S., Cassidy, L.D., & Anguzu, R. (2025). Correlates of behavioral and emotional disorders among school-going adolescents in Uganda. PLOS Global Public Health. Read the study here
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