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
On 2nd December 2024, Assoc. Professor Bruce Kirenga officially took over as Principal of the College of Health Sciences, Makerere University (MakCHS) in a handover ceremony held in the College Board Room. Dr. Kirenga succeeds Professor Damalie Nakanjako, who successfully completed her four-year term.
The ceremony was attended by members of the MakCHS Administrative Board and key university leaders, including Ag. Deputy Vice Chancellor (Finance and Administration) Professor Henry Alinaitwe, Chief of Human Resources, Mr. Deus Tayari Mujuni, & Deputy University Secretary Mr. Simon Kizito, among others.
In her remarks, Professor Nakanjako reflected on her time in office with gratitude and pride since she assumed office in December 2020. She expressed her full support for MakCHS in contributing towards training and research in Makerere University.
Professor Nakanjako thanked the university top management for the support rendered to during her term of office as Principal. I thank family, friends and colleagues who supported and allowed me share my time with the college, especially beyond official hours.
Dr. Kirenga, a pulmonologist, researcher, and founding director of the Makerere University Lung Institute, expressed his heartfelt gratitude to the Makerere leadership and the search committee for entrusting him with the responsibility of steering the college. He noted; “It’s a true honour to have been entrusted with this role. The search process was rigorous, but I learned so much from the ideas shared by my colleagues—it was a truly honourable competition.”
With a vision for collaboration and growth, Dr. Kirenga outlined his priorities, including improving staffing, improving relationships with teaching hospitals, and addressing infrastructure needs. He emphasized a leadership style rooted in inclusivity and teamwork, saying, “Let’s create a common vision through consultation and work together. I’ll visit every unit in the college to hear directly from staff about their challenges, needs, and ideas for moving forward.”
Dr. Kirenga also shared plans to establish a forum of past leaders to harness their collective wisdom and ensure continuity in leadership.
Four Makerere University School of Public Health (MakSPH) faculty have been inducted for the 2024 Uganda National Academy of Sciences (UNAS) fellowship, a preeminent nation’s most respected scientific bodies. This is the first time MakSPH is scooping a large number of faculty fellows, which was the highest for a single institution. This prestigious honor was awarded on Friday, November 1, 2024, at Four Points by Sheraton Kampala, Uganda.
The recipients are;
⦿ Professor David Guwatudde, a Professor of Epidemiology and Biostatistics at the MakSPH where he has been teaching for over 32 years. In the last decade, Dr. Guwatudde’s research interest has been on characterising the epidemiology, evaluattion and effectiveness of appropriate interventions for prevention and control of selected non-communicable diseases (NCD) especially diabetes and hypertension.
⦿ Dr. Fredrick Edward Makumbi, an Associate Professor of Biostatistics at MakSPH in the Department of Epidemiology and Biostatistics. A seasoned public health professional in Uganda, he is also a Gates Fellow. Through his expertise in population health and the evaluation of public health interventions, Dr. Makumbi has generated significant evidence that impacts the field. He has published over 300 journal articles and leads the PMA project, which focuses on evaluating schistosomiasis and family planning initiatives in Uganda.
⦿ Dr. David Musoke, a Senior Lecturer in the Department of Disease Control and Environmental Health at MakSPH. He serves as the Chair of the Grants and Research Capacity Building Committee at MakSPH and is the President Elect of the International Federation of Environmental Health (IFEH). A graduate of Makerere University, his research interests include environmental health, malaria prevention and community health. He organized the first International Community Health Workers symposium which was held in Uganda, and is an academic editor and reviewer for several journals.
⦿ Dr. Victoria Nankabirwa, an experienced clinical researcher and Lecturer in the Department of Epidemiology and Biostatistics at MakSPH. She holds a PhD from the University of Bergen and is also a member of the WHO Immunization and Vaccine-related Implementation Research (IVIR) Advisory Committee. Her key interests include mother and child outcomes, particularly survival and the impact of immunization.
UNAS is an independent, non-profit, and non-political organization, established and founded in October 2000 to provide Uganda with credible, balanced, and evidence-driven guidance on matters of science and development. Membership is drawn from distinguished scientists and scholars who have made significant, lifelong contributions across diverse fields, including natural and social sciences, arts, and humanities.
The UNAS Fellowship remains one of the nation’s most respected scientific bodies, with over 200 members working collaboratively in interdisciplinary and transdisciplinary fields to address Uganda’s challenges through science and innovation.
Every year, Fellows of the Uganda National Academy of Sciences (FUNAS) have an opportunity to nominate potential fellows into the academy based on their merit, impact and contribution of the world of Science. A nomination stands substantive once it is seconded by another FUNAS, after which the nominees go through a rigorous selection process by a highly competent committee of scholars in the academy.
Once selected and inducted, fellows in the academy devote their time on honorific activities and service provision through arbitrating on contentious national debates such as whether to provide free social services to refugees and whether to use DDT to control Malaria. Since inception on October 20, 2000, the UNAS has distinguished itself as a premier honorific society for eminent scientists in Uganda. It leverages on the expertise and stature of its members to provide pro bono evidence-informed advice to government and Ugandans on science, technology, innovation and sustainable development.
Dr. David Serwadda, an Exemplar Scholar of Makerere University who this year received the prestigious Professor Emeritus title presented the new fellows to the UNAS convention. He described Dr. Nankabirwa as a prolific researcher, with over 80 publications in peer-reviewed journals and an impressive funding portfolio that includes a number of highly competitive research grants.
On her part, Dr. Victoria Nankabirwa said she was grateful for the recognition and pledged to uphold UNAS values.
“I am very thankful for this recognition, and as I reflect on the journey that has brought me to this point, I am reminded that this is not the result of solitary work but of shared aspirations, collaborations, and partnerships. As such, I am very thankful to my nominators and seconders, Prof. David Serwadda and Prof. Rhoda Wanyenze, as well as to my colleagues, my students, and my family, represented by my mum. To these people and to you, I extend my deepest gratitude. I pledge to uphold the academy’s values, advocate for science-driven policies, and mentor future generations. I will work as hard as I can within this FUNAS,” said Dr. Nankabirwa.
Dr. Fredrick Edward Makumbi expressed his gratitude and commitment during his recent induction as a fellow of the Uganda National Academy of Sciences (FUNAS). “I am delighted to have been nominated and accepted as a FUNAS. I am truly appreciative and acknowledge the support of all those who have helped me, from my family to my teachers and colleagues—many of whom are here today. They have supported me and brought me to this great podium. I pledge to continue working, supporting, and promoting the health and well-being of the people of Uganda and beyond through science, as well as mentoring others to ensure a sustainable generation that can uphold the health and well-being of Uganda and beyond. I am glad to be here, and thank you very much,” Dr. Makumbi stated.
Dr. David Musoke is a promising researcher and Senior Lecturer in the Department of Disease Control and Environmental Health at Makerere University’s School of Public Health. He serves as the Chair of the Grants and Research Capacity Building Committee and is the President Elect of the International Federation of Environmental Health (IFEH).
“I am really delighted and humbled to be joining this elite class of academics and scholars as a fellow of UNAS. It is an honor to join many of my mentors from over the years, including my very own father, who is also a fellow of UNAS and is here today, Prof. Miph Musoke. I wish to thank my family—my parents, wife, and children—for all their support, as well as the research teams we have worked with,” said Dr. David Musoke.
Adding that; “I also extend my gratitude to my mentors from the university, Professor David Serwadda and Professor Rhoda Wanyenze, for nominating me, along with all the others who have contributed throughout this journey, including funders, collaborators, the community, and everyone else we work with. I look forward to serving in this capacity and upholding the goals and aims of UNAS, especially in the field of Environmental Health and Community Health.”
Professor Guwatudde, a lead investigator in two national surveys assessing non-communicable disease (NCD) risk factors in his country—first in 2014 and again in 2023—expressed his commitment to tackling NCDs as he was recognized by the Uganda National Academy of Sciences (UNAS).
“I would like to thank the UNAS council, the secretariat, and all members for accepting me as a member,” Prof. Guwatudde said.
“I pledge to contribute in the area of non-communicable diseases. We have conducted extensive research in this country, giving us a clear picture of the NCD burden, a reality that affects us all. I would be glad to share this insight with fellow members,” added Guwatudde.
National academies worldwide provide neutral platforms for experts across disciplines to tackle societal challenges and clarify emerging issues in science, technology, and policy. These institutions play a crucial role in preparing for and responding to global threats such as pandemics. Since its inception, the Uganda National Academy of Sciences (UNAS) has been led by four presidents: Prof. Paul Mugambi (2000-2014), Prof. Nelson Sewankambo (2014-2019), Prof. Peter Mugyenyi (2019-2022), and, since October 2022, Prof. Grace Bantebya-Kyomuhendo, a Professor of Women and Gender Studies at Makerere University—the first female head of the academy.
Prof. Bantebya extended her congratulations to the newly inducted fellows. She emphasized the responsibilities UNAS fellows carry, including upholding the academy’s constitution and contributing to its vision, mission, and objectives. “Our fellows play a critical role in advancing the academy’s goals, and their dedication is vital to our impact on science and policy,” Prof. Bantebya stated.
“Remain academically active. Please listen to that. In meaningful pursuit of academic excellence in your respective areas of expertise. Do not say that now that you have become a fellow, you will stop being academically active. We expect you to continue,” she emphasised.
She also called on the fellows to actively participate in the academy’s conventions, consensus-building efforts, and other activities. Prof. Bantebya emphasized the importance of consensus studies to the academy’s mission, urging fellows to make themselves available when called upon.
“Ensure high standards of conduct based on national and international best practices. We expect you to maintain and ensure high standards yourselves and foster good relations among members as well as with the academy, the general science community, and the public. You also need to meet all the obligations as a fellow of UNAS, whether financial or otherwise, as stipulated,” the Academy President said
A fellow may lose their membership in the academy if they act against the UNAS constitution or bring disrepute to its goals, name, or vision. Membership can also be terminated if a member is convicted by a competent court or authority of a felony or serious crime, or if they are declared bankrupt or of unsound mind.
UNAS’s mission is to foster the welfare and prosperity of the Ugandan people by generating, sharing, and utilizing robust knowledge and insights to deliver independent, merit-based scientific counsel to government and society. As part of the global scientific community, UNAS maintains strong ties with the Network of African Science Academies (NASAC), Network of Science Academies in Islamic Countries (NASIC), the U.S. National Academies, IAP, and TWAS.
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