Health

COVID-19: Handwashing Adherence Drops by 93% in Kampala Hotspots

Published

5 years ago

January 4, 2021

Mark Wamai

The Minister of Health-Hon. Dr. Jane Ruth Aceng washes her hands after the CCP launch on 16th September 2020 using the Touchless Handwashing Kit (TW-20) developed with support from the Government of Uganda through Mak-RIF

_{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.

*Community and local government leaders at the ALERTs study Validation and Co-Design Workshop on COVID-19 in Kampala slums. 5th Left is the Project PI Dr. Gloria Seruwagi*

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.

*Dr Gloria Seruwagi, Principal Investigator of ALERTs Study, at the Validation and Co-Design event.*

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%).

*Hilda Namakula a Co-Investigator of the ALERTs study presenting the Key Findings at the ALERTs Validation and Co-Design Event*

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.

*Mr. Henry Bwire, an official from Kawempe Division, gives input in the co-design process*

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.

*Catherine Nakidde, Co-Investigator on the ALERTs Study, presenting on the National Community Engagement Strategy (CES)*

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.

*Ms. Carol Kamugira, the Mak-RIF Engagement Officer, gives her remarks at the event*

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

Related Topics:ALERTs COVID-19 Handwashing hygiene Kampala Mak-RIF prevention slum study

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Health

The silent teachers: why body donation matters

Published

4 hours ago

June 5, 2026

Mak Editor

Assoc. Prof. Erisa Sabakaki Mwaka, Consultant Orthopaedic Surgeon and Chair, Department of Anatomy, College of Health Sciences (CHS). Makerere University, Kampala Uganda, East Africa.

_{By Assoc. Prof. Erisa Mwaka and Joyce Nabukalu-Kiwanuka}

In every hospital, there is a moment when knowledge becomes a matter of life and death. A doctor must know where to place an incision, how to avoid damaging major organs, how to identify a nerve, how to deliver a baby safely, how to interpret a scan, or how to explain disease to a worried family. That knowledge does not begin in the operating theatre, it begins much earlier, in the anatomy laboratory.

For generations, the study of the human body has been the foundation of medical education. The regular use of human bodies for medical training purposes began in the late Middle Ages and spread during the 18th and 19th centuries. Initially, anatomists depended on gallows, poor houses, mental asylums, or jails as sources of bodies. However, the 1960s and 1970s saw the emergence of wilful body donation. Before students become doctors, surgeons, dentists, nurses, physiotherapists, radiographers, and other health professionals, they must first understand the human body in its real form. They must learn not only from books and diagrams, but from the body itself. This is why cadavers, though silent, remain the most important teachers in medical education. In simple terms, a cadaver is a dead human body used by health professions students to study anatomy; and Anatomy is the study of the physical structure and organization of the human body, both at macroscopic and microscopic levels.

As the Department of Anatomy at Makerere University College of Health Sciences prepares to commemorate the “silent teachers” whose bodies are used for medical education on June 11, 2026, Uganda is invited to reflect on a subject that is rarely discussed in the public domain, willed body donation. Body donation simply means a person willfully donates their body for educational purposes after death, and consent to it in life. This is a sensitive topic, but it is also a deeply human one. It touches our beliefs, families, culture, understanding of death, and responsibility to future generations.This commemoration ceremony is not symbolic but, it is a public statement that the contribution of silent teachers is sacred, educational, and deeply appreciated.

To donate one’s body after death is not an ordinary decision; it is an altruistic act of extraordinary generosity. It is a final gift to society. It allows health professions students to learn and appreciate the human body before they treat living patients. Cadavers are therefore not “specimens”, they are silent teachers and partners in medical education who continue to serve humanity even after death. Learning anatomy using a cadaver helps students to understand and appreciate the complexity of the human body, appreciate its natural variations, and develop the confidence and competence needed to serve the public. Students are also taught laboratory etiquette that emphasises dignity, empathy, and utmost respect for the cadavers, which attributes they carry into the clinical years when they interface with hospital patients.

In Uganda, where the demand for health workers continues to grow, medical education must be strengthened at every level. Our country needs well-trained doctors and health professionals who can serve in hospitals, health centres, universities, research institutions, and communities. But good training requires good teaching resources. One of these resources are the silent teachers who never complain, but impart immeasurable knowledge to future health professionals. Modern technology has introduced many useful tools into medical education. Students can now learn from videos, computer applications, digital images, plastic models, three-dimensional models, and virtual platforms. These tools are important and should be embraced, however, they cannot completely replace learning from the real human body. A cadaver teaches what a diagram cannot fully show; the true position of organs, the texture of tissues, the relationship between structures, and the natural differences that exist from one person to another. More importantly, cadaver-based learning teaches respect. It reminds students that medicine is not simply a technical profession, it is a calling rooted in human dignity. The first lesson students learn in the anatomy laboratory is that the body before them belonged to a person who had a name, a family, a story, and a life. That lesson shapes how they later treat patients.

Currently, most, if not all universities in Uganda, and similar settings in Africa use unclaimed bodies for learning Anatomy. The use of cadavers in Uganda is governed by the Penal Code (Anatomy Rules) of 1957 that permits public hospitals to transfer bodies unclaimed for at least 14 days to a medical training institution like Makerere University. Unfortunately, these cadavers are used without the consent of the deceased because most of them are unknown and with no known relatives to claim them. Many opponents to the use of unclaimed bodies opine that the practice is unethical. There is a global push toward ethical use of cadavers in medical education, where a person consents and bequeathes his/her body for medical education when still alive. For this practice to be sustainable, there is a need for a well regulated body donation program. Unfortunately, the concept of willful body donation is still not well understood by many people, and neither has it been a topic of public debate. Further, there are lots of myths surrounding death and dying in Africa, including Uganda that have hindered the establishment of successful body donation programs. Willingness to donate bodies for medical education is however, influenced by several factors including cultural and religious beliefs, respect for the dead and the need to fulfil burial rites, fear for mutilation and disrespect, to mention a few. These concerns are real and should not be dismissed. But they should be addressed with accurate information, openness, and utmost respect.

It is important to understand that body donation does not mean that a person is forgotten. On the contrary, it creates a legacy. A body donor may teach hundreds of future health professionals, in that way, one person’s final act of generosity can touch and save countless lives. This is kind of patriotism is largely unkown in Uganda and we do not speak about enough. We often talk about serving our country through leadership, business, farming, teaching, parenting, or community service. But there is also service beyond life. Body donation is one way of saying: “Even when I am gone, let me contribute to the health of my people.”

Currently, Uganda now has more than 15 universities training medical students and the demand for cadavers for learning anatomy is on the rise. Actually, the supply of cadavers cannot fulfil the demand, and medical educationists need to find alternative source of cadavers. Wilful body donation is the answer.

Uganda needs a national conversation on body donation. There is a need for deliberative public engagement involving various stakeholder including the public, religious and cultural leaders, civic leaders, the media, educationists, health professionals, medical training institutions, etc.

This commemoration ceremony will involve inter-denominational prayers for the silent teachers, and a reflection of their contribution to healthcare in Uganda. We hope this ceremony will provoke public debate on a subject that is hitherto considered a taboo by many. We talked about some of these issues last year, in the first ever such ceremony in Uganda, and have received several requests for more information on the procedure for donating one’s body for teaching purposes upon death. Like President Obama’s said, “yes we can”, an the dialogue starts from you and me. You are all invited for the commemoration ceremony at 9.00 am on June 11, 2026, at the Makerere University School of Public Health auditorium on main campus.

To donate one’s body is to give a final lesson, a final service, and a lasting gift to the nation.

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Health

Makerere Health Services Guidance on Ebola Virus Disease (EVD)

Published

4 days ago

June 1, 2026

Mak Editor

How to protect yourself and your loved ones from Ebola. Ministry of Health, Kampala Uganda, East Africa.

The Democratic Republic of Congo (DRC) and Uganda recently reported an outbreak of Ebola Virus Disease (EVD), which is a serious and often deadly disease caused by a person being infected by the Ebola virus.

The virus spreads through direct contact with body fluids such as blood, saliva, faeces, vomit, urine, sweat or genital fluids from a person who is infected with EVD.

The symptoms of EVD usually develop after 8 – 10 days from contact with an infected person and may include fatigue, high fever, headache, sore throat, muscle and joint pains, vomiting and diarrhea and in severe cases, bleeding.

What should we do as the Makerere University community?

The Chief, Makerere Health Services, Prof. J.K. Byamugisha advises as follows:

Avoid unnecessary contact such as shaking hands, hugging etc.
Place alcohol disinfectants or hand washing equipment at all entry points within the University and ensure everyone is using them.
Students should sit in single-person chairs while in class, avoiding contact with their neighbours.
Do not sit too close to one another especially in frequently crowded places such as classrooms, library or any other waiting area.
While at the University Hospital, wash hands a the gate, use alcohol disinfectant at the reception.
All patients should have a maximum of one caretaker – others can check on them by calling.
Avoid bringing luggage to the University Hospital.
Target to do as instructed by the health worker.
For further information and guidance on Ebola, please call Dr. Charles Basigara on Tel: 0702 966652 and Sr. Eunice Namubiru on Tel: 0779 950978 (Contact persons for the University Health Services)

Additionally, always look out for and ensure full compliance with Ministry of Health (MoH) Infection Prevention and Control measures such as the one below.

How to report suspected Ebola cases to Health Authorities. Ministry of Health, Kampala Uganda, East Africa. — ***How to report suspected Ebola cases to Health Authorities.***

Please find attached detailed communications from Prof. Byamugisha and
the Permanent Secretary Ministry of Health.

Makerere-Health-Services-Ebola-Virus-Disease-Memo-28-May-2026 Download

Ministry of Health Circular on Mass Gatherings Download

Health

Call for Applications: Masters Support in Self-Management Intervention for Reducing Epilepsy Burden

Published

2 weeks ago

May 25, 2026

Mak Editor

An aerial photo of the College of Health Sciences (CHS), Makerere University showing Left to Right: The Sir Albert Cook Memorial Library, School of Biomedical Sciences, Davies Lecture Theatre, School of Public Health, Mulago Specialised Women and Neonatal Hospital (MSWNH)-Background Left and Nakasero Hill-Background Right, Kampala Uganda, East Africa.

The Makerere University College of Health Sciences and Case Western Reserve University, partnering with Mbarara University of Science and Technology, are implementing a five-year project titled “Self-management Intervention for Reducing Epilepsy Burden Among Adult Ugandans with Epilepsy.”

The program is funded by the National Institute of Health (NIH) and the National Institute of Neurological Disorders and Stroke (NINDS). One aspect of the program is to provide advanced degree training to qualified candidates interested in pursuing clinical and research careers in Epilepsy. We aim to grow epilepsy research capacity, including self-management approaches, in SSA.

The Project is soliciting applications for Master’s Research thesis support focusing on epilepsy-related research at Makerere University and Mbarara University, cohort 3, 2026/2027.

Selection criteria

Should be a Master’s student of the following courses: MMED in Internal Medicine, Paediatrics, Surgery and Neurosurgery, Psychiatry, Family Medicine, Public Health, Master of Health Services Research, MSc. Clinical Epidemiology and Biostatistics, Nursing, or a Master’s in the Basic Sciences (Physiology, Anatomy, Biochemistry, or any other related field).
Should have completed at least one year of their Master’s training in the courses listed above.
Demonstrated interest in Epilepsy and Neurological diseases, care and prevention, and commitment to develop and maintain a productive career, and devoted to Epilepsy, Clinical Practice, and Prevention.

Research Programs:

The following are the broad Epilepsy research priority areas (THEMES), and applicants are encouraged to develop research concepts in the areas of: Applicants are not limited to these themes; they can propose other areas.

The epidemiology of Epilepsy and associated risk factors.

Determining the factors affecting the quality of life, risk factors, and outcomes (mortality, morbidity) for Epilepsy, epilepsy genetics, and preventive measures among adults.
Epilepsy in childhood and its associated factors, preventative measures etc.
Epilepsy epidemiology and other Epilepsy related topics.
Epilepsy interventions and rehabilitation

In addition to a formal master’s program, trainees will receive training in bio-ethics, Good Clinical Practice, behavioral sciences research, data and statistical analysis, and research management.

The review criteria for applicants will be as follows:

· Relevance to program objectives

Quality of research and research project approach
Feasibility of study
Mentors and mentoring plan; in your mentoring plan, please include who the mentors are, what training they will provide, and how often they propose to meet with the candidate.
Ethics and human subjects’ protection.

Application Process

Applicants should submit an application letter accompanied by a detailed curriculum vitae, two recommendation letters from Professional referees or mentors, and a 2-page concept or an approved full proposal describing your project and addressing Self-Management Intervention for Reducing Epilepsy Burden Among Adults or an epilepsy-related problem.

For more information, inquiries, and additional advice on developing concepts, don’t hesitate to get in touch with the following:

Makerere University College of Health Sciences

Prof. Mark Kaddumukasa: kaddumark@yahoo.co.uk

Mbarara University

Ms. Josephine N Najjuma: najjumajosephine@yahoo.co.uk

Only short-listed candidates will be contacted for Interviews.

A soft copy should be submitted to the Administrator of the Epilepsy Project. Email: smireb2@gmail.com; Closing date for the Receipt of applications is 5^th July 2026.