Health
COVID-19: Handwashing Adherence Drops by 93% in Kampala Hotspots
By Joseph Odoi
As Uganda continues to fight tirelessly to control the spread of COVID-19, results from a field-based survey in Kampala’s informal settlements have indicated that citizens have abandoned hand hygiene, a key pillar in stopping the spread of a virus.
To beat the virus today and ensure better health outcomes beyond the pandemic, hand hygiene, especially through handwashing with soap have been emphasized as a top priority.
But results of a study titled: Adherence, Lived Experiences and Resilient Transformation among “slum dwellers” (ALERTs) in COVID-19: A study of Ki-Mombasa and Kabalagala-Kataba slums in Kampala present an urgent need to intervene in these communities in order to improve public hygiene practices such as handwashing, if the intended objectives are to be achieved.
Dr. Gloria Seruwagi, a behavioural scientist at Makerere University School of Public Health has observed that some of the set Standard Operating Procedures such as physical distancing, regular sanitizing and use of face masks are less likely to be followed and implemented due to congestion in the settlements.
While presenting an overview of results from the study, Dr. Seruwagi said Ugandans had gone back to their old ways and abandoned best hygiene practices such as handwashing, which is critical in the fight against COVID-19.
“Residents say they can’t afford masks and those who have them say masks make breathing uncomfortable. Sanitizing is a luxury to most people in Bwaise and Kataba communities. While the practice of handwashing was feasible and adhered to at the beginning of March, it has drastically dropped by up to 92.6%.
Dr. Seruwagi, who is also the Study Principal Investigator observed that residents of Ki-Mombasa and Kabalagala-Kataba still have a major infodemic challenge of misinformation surrounding COVID-19, also exacerbated by multiple power centres and enforcers who locals say give confusing messages and seemed to have an uncoordinated response strategy.
“The community told us that everyone seems to be a “little king” in enforcing COVID SOPs and guidelines – from the police to Division leaders, food distributors, VHTs and local village leaders. They were not working in harmony and were giving different, sometimes confusing, messages and instructions. This greatly contributed to confusion and partly resulted in community noncompliance” she said.
According to Hilda Namakula, ALERTs study Co-Investigator people living in informal settlements had vast knowledge of COVID-19 signs, symptoms and how it is spread.
For instance, in this study, up to 82% mentioned high fever as a symptom while 80.2% mentioned sore throat as a symptom. Meanwhile 80.8% knew that sneezing and coughing were symptoms and 78% mentioned body pain.
Despite this knowledge, Namakula contends that communities have multiple – and sometimes contradictory – sources of information which affect their adherence to the preventive measures.
“In Kampala, TV takes lead as the main information source at 78%, social media 14%. Other sources include radio, family members and neighbors. In addition to multiple information sources, multiple enforcement authorities in Ki-Mombasa and Kabalagala-Kataba have contributed to confusion on which information to follow.’’ said Ms. Namakula.
In a bid to establish reasons for non-compliance to COVID-19 SOPs such as physical distancing or staying home, researchers also found that livelihoods and the need to make a living were the most common explanatory factors.
“Other reasons for non-compliance include perceptions that COVID-19 is a political ploy, declining enforcement and multiple implementers with confusing messages and warring power centres. Moreover, in their power struggles, the different actors who were enforcing SOPs were themselves not adhering for example by wearing masks” Namakula added.
According to the study, communities reported lot of myths and misconceptions about COVID-19 as key drivers of high risk behaviour. For example; people living in Kampala’s informal settlements believe that taking alcohol reduces the risk of infection (16.8%); that sunbathing protects against COVID-19 (47.9%); and that Africans are immune by virtue of their skin Colour (46.5%).
Following the survey findings, Makerere University researchers underscored the need for sustainable community-led interventions to minimize the pandemic implications. The researchers observe that the current efforts to contain the pandemic cannot yield better results unless there is harmony and consistency in messages shared out.
The project team set out to engage health workers and community leaders of Ki-Mombasa Bwaise and Kabalagala-Kataba slum communities to jointly co-design tailored interventions on Thursday 17th December 2020. The engagement climaxed with a dialogue held at Makerere University Central Teaching Facility (CTF-1) with key stakeholders in attendance, including representatives from Makerere University, Kampala Capital City Authority (KCCA), Division and political leaders, Village Health Teams (VHTs), community, administrative leaders, religious leaders among others.
Following presentation of findings, there was consensus from all participants that it was still possible to reverse the non-adherence and high-risk behaviour.
The stakeholders identified priority areas for interventions underscoring the need for community leaders (Village Chairperson, VHTs) to be at the forefront. The co-design process comprised proposals for re-adaptation of some existing interventions or focusing more on some than others (e.g. emphasising wearing facemasks vs. social distancing); and practical ways for operationalizing the Community Engagement Strategy (CES) amidst increasing community transmission; designing a community behavioural change communication component; as well as undertaking joint rigorous resource mobilisation at the next phase to implement some of the proposed interventions.
Government of Uganda through the Ministry of Health launched the National Community Engagement Strategy (CES) for COVID-19 Response in October 2020. This strategy arose from the need to stem the wide spread community transmission amidst low levels of compliance to the COVID-19 SOPs.
This strategy puts responsibility to community individuals, local leaders, households and communities to take charge and ensure optimal compliance. The CES also spells out the key role of VHTs, other local leaders the roles of the proposed village health Taskforce (VTF) and expected outcomes.
This study is funded by the Government of Uganda, through the Makerere University Research and Innovation Fund (MakRIF). The ALERTs study is dual-pronged and phased in implementation that combines an innovative citizen science approach with a participatory project co-design phase.
Ms. Carol Kamugira, a Mak-RIF representative applauded the research team for being innovative and bringing community members to devise community-led sustainable solutions in the fight against the coronavirus.
“It is the first time I have seen this kind of arrangement, bringing real community members to co-design interventions here at the university. Such interventions will be successful because they came from the people concerned and who will monitor the process. As the RIF we are very proud of Dr Seruwagi and her team and that is why we are here to support such meaningful studies. The government gave us resources, we advertised and received many research proposals. The proposal for this research was among those selected for funding because it was strong and very innovative,” Ms. Kamugira said.
She hailed the Uganda Government for the support rendered towards research and other training needs at Makerere University.
Other Key Findings
• The living arrangements in the informal settlements affect people’s adherence to SOPs like social distancing –emphasis should be on encouraging them to adhere to the other more plausible measures like hand washing or wearing masks.
• The participants reported doing the following often: the washing of hands with water (38.3%); washing hands with water and soap (33%); covering the mouth while sneezing/coughing (28.5%); using a mask while in a public place (32.2%); consumption of fruits (25.8%); regular drinking of water (35.5%).
• A big proportion of the study participants knew that chronic illness increases the risk of death from COVID-19 (81%); and that those infected with the disease should be isolated (93%).
• While children living in informal settlements were aware of COVID-19, they are generally not adhering to the SOPs because it is believed that their age group is not at risk.
• COVID-19 has increased levels of violence, including violence against children and SGBV. It has also significantly contributed to increased cases of defilement, early marriages, teenage pregnancy and pimping children for transactional sex. For example, forced sex among the respondents during lockdown was reported at 2% and slapping 4%.
• The study also revealed that some men are survivors of violence whose condition has been worsened by COVID through not having an income source and depending on their wives who job is commercial sex work (CSW). Other men are clients of CSWs who target them claiming nonpayment; or their husbands who don’t want clients sleeping with their partner.
• Study findings also highlight some adults, including parents, local leaders and law enforcement officers as being more collusive than supportive in cases involving violence against children.
• Local duty bearers and key stakeholders in child protection such as social workers and police officers need more support to effectively undertake their roles in child protection and wellbeing.
• Schools remain both a cognitive and physical safe space for children. The closure of schools presented heightened vulnerability for children as they became more exposed, over prolonged periods of time, to multiple rights violation including lack of food and all forms of violence. Nearly all children in study sites are not benefitting much from the Education Continuity Programme and most caregivers were not in position to support learning during school closure. Children wanted to return to school and worried about an uncertain future.
• There is also evidence of belief of the politicization of COVID-19 for example the impression that the related measures are intended to curtail the activities of the opposition politicians.
• Slum communities reported limited knowledge and access to COVID-19 testing services in their communities or within Kampala as a whole.
Recommendations:
The researchers recommend that, building on from its massively successful awareness campaign on COVID-19, government should now work on addressing the barriers of non-compliance; emphasising personal responsibility and the community’s own contribution in the fight against COVID-19.
Moving forward, the researchers recommend that:
1. Government and all stakeholders should focus on addressing the drivers of non-compliance and enforcement fatigue. These drivers include:
- The feasibility of interventions: Guidelines like physical distancing are not feasible in crowded informal or slum settings and need to be revisited. Emphasis should be placed on feasible ones like hand washing and masking.
- Myths and negative perceptions: Majority of the community has not fully bought into the seriousness ofCOVID-19 and think it is not only a joke but is also a political and monetary ploy advanced by politicians, some scientists and supremacists or population control enthusiasts. These myths need to be addressed.
- Shielding community from the reality of COVID as cases are managed out of the community. More profiling of COVID-19 trends and cases should be undertaken for behavioural change impact. 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”.
2. The issue of livelihoods and food security must be resolved as a key bottleneck to compliance.
3. Innovative multi-sectoral and tailored approaches should be adopted to address COVID-19 effects, including violence against children, men and women.
4. Children and adolescents should be effectively targeted in COVID-19 interventions. They need awareness, products (e.g. fitting face masks), voice and protection from the effects of COVID-19 including being witnesses and victims of different forms of violence.
5. Local and community leader 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 putting their lives at risk.
6. The timeliness and critical role of the recently launched Community Engagement Strategy should be leveraged. Local health system capacity should be strengthened and equipped to effectively take up the implementation and enforcement of SOPs for COVID-19 prevention. Equip community health systems and other enforcement structures with the knowledge, required supplies and supportive infrastructure.
Mak Researchers-Slum Communities Designing interventions
In this dissemination, Makerere University researchers and slum community leaders and journalists engaged in co- designing behavioural change interventions to address COVID-19. The results of these sessions will form the final part of the ALERTs study objectives and will be presented in its final reporting. However, some of the suggested “quick” solutions from the groups include:
- Involvement of women in sensitization drives around COVID-19
- Preventive treatment of suspected cases
- Skilling of Youth at Village Level
- Health Education
- Incorporating church leaders in the fight against COVID-19
- Politicians should incorporate COVID-19 Messages in their campaigns
- There is need for VHT support to counter community Spread
- Cultural leaders should join the sensitization
- Incorporate Youth Leaders in awareness
- Have local leaders and Police enforcing directives
- Incorporate NGOs in the fight against COVID-19
- Employ musicians in COVID-19 since they have a huge following
- There is need to incorporate drama and plays with key messages highlighting COVID-19 dangers and how to fight it.
More about the Study
The ALERTS Study was conducted by researchers from Makerere University and Gulu University with funding by Government of Uganda through the Makerere University Research Innovation Fund (MakRIF).
The total number of study participants was 807 in two slum communities of Kampala i.e. Kataba-Kabalagala-Kataba in Makindye and Ki-Mombasa Bwaise in Kawempe Division.
The Study Team:
1. Dr. Gloria Seruwagi – PI, Makerere University
2. Prof. Stephen Lawoko – Co-Investigator, Gulu University
3. Catherine Nakidde Lubowa – Co-Investigator, CHASE-i
4. Hilda Namakula – Co-Investigator, CHASE-i
5. Dr. Eric Lugada – Co-Investigator, CHASE-i
6. Daniel Magumba – Coordinator, Makerere University
7. Flavia Nakacwa – Administrator, Department of Social Work and Social Administration, Makerere University
Article originally posted on MakSPH
Health
Ministry of Health Launches National University Health Screening Initiative at Makerere 92nd Guild Medical Camp
Despite a morning downpour, the two-day 92nd Makerere University Guild Annual Medical Camp successfully commenced on September 17, 2026 with a launch at the Freedom Square.
The Launch marks a strategic partnership between the Ministry of Health and higher education institutions to advance physical well-being and awareness of students from public and private universities.
Presiding over the event, the Minister of State for Health (General Duties), Hon. Anifa Kawooya Bangirana, launched the intensified testing and active case finding for Malaria, HIV/AIDS and Sickle Cell Disease.
Ministry officials emphasized that laboratory screening and diagnostic testing are critical entry points for early detection, linkage to care, appropriate clinical management, surveillance and prevention, and the Ministry of Health pledges full support to strengthen these services across universities nationwide.
Held under stewardship of the Makerere University Dean of Students office, the camp offered a comprehensive suite of health services to the student body and the wider community. Attendees had access to the following services:
- General and Specialist Consultations
- Sickle Cell, Malaria RDT and HIV Screening
- Eye Care and Laboratory Diagnostics
- Free Essential Medicines
- Reproductive Health Counseling
- Mental Health Counseling
While addressing the attendees, Hon. Kawooya emphasised that health is synonymous with national economic productivity.
She guided the youth to prioritise well-being, and avoid living in denial for it is the first step to refusing help. This will help build a firm foundation for any future contributions to national development.
The Minister further warned students against risky behaviours, including substance abuse and sexual immorality, which she described as poisonous.
She advocated for responsible reproductive health practices, urging students to utilise resources available to protect themselves for the future.
Why you should Know Your Status
Prof. Charles Olaro, who is the Director General of Health Services at the Ministry of Health, Uganda reflected on his time at the university during the peak of the HIV epidemic, recalling a visit from the late Bongole Lutaya.
He noted that today’s youth have not witnessed the severity of the AIDS due to the availability of care and ARVs, which can create a false sense of security.
“People are in care and you have not seen the real slim disease. You have not seen it”
He added that some attending are products of mothers that undertook prevention of mother-to-child transmission of HIV, and they gave birth to negative children. But now when we are grown up, they are reckless with their sexual life.
Prof Olaro summarized his remarks by noting that health is an irreplaceable asset and that decisions made today have significant future ramifications. They urge the audience to take the opportunity to know their status, whether for HIV or sickle cell disease, as this is the essential entry point for care and life planning.
Benefits of knowing your status:
- It serves as the entry point for receiving necessary care.
- It allows for better life planning.
- It enables individuals to manage other aspects of their lives effectively.
- It prevents future health complications.
Genetic Awareness and Blood Donation
Associate Professor Richard Idro the Deputy Principal of the Makerere University College of Health Sciences (MakCHS) emphasised the importance of seeking appropriate information with a focus on genetic awareness. He advised the students to know their status before marriage to prevent passing on genetic conditions.
“One day when you fall in love, you know that preferably you should not marry somebody who is also carrying a certain gene.”
He then delved into the importance of treating HIV and clearing malaria parasites, which he addressed exhaustively.
From this, Dr Idro’s focus turned to blood donation where he acknowledged a number of people that had already participated in the exercise at the Uganda Red Cross Society tent.
“I see the Red Cross at one corner. As we passed there, 36 people had donated blood. Although, gentlemen, I saw very few of you donate blood.”
He concluded by challenging the young men present and reminding them that they can donate blood up to four times a year and still remain healthy.
Empowering Ambassadors of Global Health Awareness
The Ministry of Health called upon the students attending the camp to serve as ambassadors for global health awareness in their respective institutions.
The Executive Director/Commissioner National Health Laboratory and Diagnostic Services (NHLDS), Dr. Susan Nabadda Ndidde advised the students to make sure that they mobilise and intensify testing for all these diseases.
“We will work with you as a Ministry to provide the tests to make sure that we know your status and prevent these diseases in time.”
She wrapped up her message by thanking Makerere for allowing the Ministry of Health to partner on this cause and urged the students to embrace this opportunity and make sure they leave after establishing their status.
By bringing these critical services directly to campuses, the government fosters a healthier, and more informed generation capable of driving Uganda’s future development.
Students Appreciate the Medical Camp
According to Denise Kainomugisha, the Chairperson of the Makerere University School of Public Health (MakSPH) and Vice Minister of Health in the 92nd Guild, the Camp served as a vital platform for capacity building.
“The screening, the testing, the sports science, was all handled by the student volunteers under supervision” she confessed.
She also explained that the camp extended to broader public health goals and additionally fostered leadership and collaboration among students, who were encouraged to work together to address community health needs.
Concluding her remarks, Kainomugisha expressed gratitude to the respective partners for providing both financial support and the opportunity for students to take on active roles throughout the Medical Camp.
Agriculture & Environment
Makerere Hosts Inaugural Falling Walls Lab Competition as Innovators Pitch Solutions to National Challenges
Students and researchers from Makerere University and other institutions pitched 12 innovations addressing challenges in healthcare, clean energy, agriculture, waste management and community resilience during the inaugural Falling Walls Lab Kampala, held at the School of Public Health Auditorium, Makerere University.
The competition brought together emerging innovators to present solutions to practical challenges through a three minute pitch, followed by questions from a panel of judges.
Modelled on the Falling Walls format that originated in Berlin, the event required each participant to identify a “wall” a problem or barrier, and demonstrate how their innovation seeks to break it down.
Mudhasi wins with newborn jaundice screening device
Andrew Mudhasi of Makerere University emerged as the overall winner with a score of 90 per cent for a low cost medical device designed to improve newborn jaundice screening across different skin tones.
Mudhasi explained that the device uses optical sensor technology and a skin tone targeting algorithm to provide a rapid reading, with the aim of helping nurses and clinicians identify jaundice more efficiently.
During questions from the jury, Mudhasi said the device had not yet been tested on actual babies but had undergone laboratory testing using simulated skin tones.
He reported an accuracy rate of 94 per cent when the device was compared with laboratory spectrophotometers.
The innovation is intended initially for use in clinics and hospitals, with Mudhasi saying the team is also considering a version that could eventually allow mothers to screen babies at home.
Mudhasi’s innovation has previously received recognition at the African Business Concept Challenge and the iF Design Student Award, according to his presentation.
Rhonda’s innovation tackles diaper waste
Rhoda John of the University of Nairobi emerged in second place with 89.6 per cent for an innovation addressing the problem of used diaper waste.
Under the theme “Breaking the wall of diaper waste and drug soils,” Rhonda explained that her team extracts sodium polyacrylate, the absorbent polymer found in diapers, and replaces the sodium with potassium.
The resulting potassium based superabsorbent material is designed to act as a “water battery” in soil by absorbing and retaining water for plants during dry periods.
John said testing showed a 99 per cent increase in germination and a 23 per cent increase in drought resistance.
The innovation also seeks to reduce the amount of used diapers ending up in landfills and the environmental effects associated with their decomposition.
During the question and answer session, John explained that her team was working with government environmental officials in Nairobi on a pilot collection system to address the challenge of gathering used diapers at scale.
Mahera takes third place with herbal peptic ulcer treatment
Stuart Mahera of Makerere University finished third with 86.2 per cent for a herbal formulation targeting peptic ulcers.
Presenting under the theme “Breaking the wall of Nature and Modern Medicine,” Mahera argued that conventional treatment for peptic ulcers can involve multiple medicines and may be associated with side effects and antimicrobial resistance.
His proposed formulation, MARAC capsules, is intended as a monotherapy, combining properties required for peptic-ulcer treatment in a single capsule.
Mahera said his team had carried out quality control work, including characterisation and dose quantification, and had conducted preclinical trials on laboratory mice.
He also told the jury that an application had been submitted to the National Drug Authority as the team awaits the next stage of the regulatory process.
According to Mahera, the proposed seven day treatment would cost about Shs21,000, compared with the existing 14 day treatment approach.
Innovators present solutions to practical challenges
The remaining presentations covered a wide range of challenges.
Esther Nakungu of Utamu University presented Agri-Track, a digital record keeping solution intended to improve visibility, accountability and management of farm operations and financial information.
Dr. Jimmy Chachiga, a Makerere University participant, presented a solar photovoltaic cooker with a heat storage system designed to provide a cleaner and more reliable cooking option during both sunny and non sunny periods.
His presentation focused on reducing dependence on biomass fuels and addressing the challenges associated with intermittent solar energy.
Abdul Noor Luttamaguzi, a PhD student and senior government fisheries officer, presented a mobile application aimed at helping fish farmers and extension officers report, track and manage disease outbreaks.
Henry Duke Tamale presented a herbal cream targeting antibiotic resistant biofilm infections associated with diabetic foot ulcers.
Marvin Seruwu proposed adapting existing near infrared brain monitoring technology to help detect extra-axial brain bleeds in health facilities where access to CT and MRI equipment is limited.
His proposal seeks to repurpose existing technology towards a diagnostic need that could be particularly important in settings where advanced imaging facilities are not readily available.
Kennedy Kisame presented a poultry alert and diagnosis system combining satellite weather information with computer vision disease detection. The proposed system could be accessed through a smartphone application, SMS or USSD, making it potentially usable by farmers with limited internet access.
Frank Atwiine proposed a solar powered mobile diagnostic van designed to bring ultrasound and other diagnostic services closer to rural communities.
Johnson Makmot, a software and blockchain developer, presented a platform that combines GPS tracking and blockchain-based tokens to incentivise and verify plastic-waste collection in Kampala.
Dr. Nelson Ndugu, from a partner university, presented an artificial intelligence tool designed to translate agricultural research publications into local Ugandan languages and generate voice notes for radio-based extension delivery.
The final presentation came from Dr. Juliet Akola, a Ugandan post doctoral researcher at Mangosuthu University of Technology in South Africa.
Akola presented a community digital resilience initiative focused on mapping risks in Kampala’s informal settlements, including flooding, fire, poor sanitation, waste management and inadequate infrastructure.
Her proposal seeks to combine local community knowledge with geographical information systems and link identified risks to action plans involving municipalities and other stakeholders.
Nawangwe calls for more investment in innovation
Closing the event, Prof. Nawangwe congratulated all the participants and described their presentations as an important beginning for Makerere University, Uganda and the wider region.
Drawing on his experience attending the Falling Walls conference in Berlin, the Vice Chancellor said initiatives of this nature are important because innovation will play a major role in determining the future of countries.
He encouraged participants to make their pitches more precise by clearly identifying the problem they are addressing, explaining their proposed solution and demonstrating what they have already achieved.
Prof. Nawangwe also welcomed the participation of innovators from other universities and countries, noting that the Kampala event had attracted participants beyond Makerere.
He thanked the Africa Office of the Falling Walls Foundation for its role in bringing the initiative to Makerere and encouraged continued support for innovation.
The Vice Chancellor further linked innovation to Uganda’s growing youth population and the need to develop home-grown solutions to address challenges such as youth unemployment.
The inaugural Falling Walls Lab Kampala ultimately provided a platform for innovators to move ideas beyond the classroom and laboratory and demonstrate how research, technology and creativity can be applied to challenges affecting communities.
| Position | Winner | Institution | Score |
| 1st | Andrew Mudhasi | Makerere University | 90% |
| 2nd | Rhoda John | University of Nairobi | 89.6% |
| 3rd | Stuart Mahera | Makerere University | 86.2% |
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